Previous chronic symptomatic and asymptomatic cerebral hemorrhage in patients with acute ischemic stroke

Abstract

PurposeIdentifying previous chronic cerebral hemorrhage (PCH), especially asymptomatic cases in patients with ischemic stroke, is essential for proper antithrombotic management. The study aimed to further clarify the prevalence of PCH and the associated factors in patients with acute ischemic stroke using multi-modal neuroimaging including susceptibility-weighted MR imaging (SWI).MethodsThis was a retrospective cross-sectional study of 382 patients with acute ischemic stroke. All patients underwent 3.0-T MRI for cranial SWI, 1.5-T or 3.0-T conventional cranial MRI, and cranial CT. Patients found with PCH were matched 1:4 with patients without PCH. Clinical manifestation, computed tomography, conventional cranial MRI, and cranial SWI were used to determine PCH. Clinical and neuroimaging findings between the patients with symptomatic vs. asymptomatic PCH were compared.ResultsThirty-six patients (36/382, 9.4%) were determined to have had a PCH. Of these 36 patients, 17 (17/36, 47.2%, or 17/382, 4.5%) had asymptomatic PCH. Multivariable analysis showed that serum total cholesterol (OR = 0.510, 95%CI 0.312–0.832, P = 0.007), cerebral microbleeds (OR = 6.251, 95%CI 2.220–17.601, P = 0.001), and antithrombotic drugs history (OR = 3.213, 95%CI 1.018–10.145, P = 0.047) were independently associated with PCH. Asymptomatic PCH had similar clinical and neuroimaging characteristics with symptomatic PCH.ConclusionPCH is not uncommon in acute ischemic stroke patients. Total serum cholesterol, cerebral microbleeds on SWI, and history of antithrombotic drugs were independently associated with PCH in patients with acute ischemic stroke. Asymptomatic PCH, which is easier to be missed and has similar characteristics with symptomatic PCH, should draw much attention.Electronic supplementary materialThe online version of this article (10.1007/s00234-018-2141-y) contains supplementary material, which is available to authorized users.

Stroke Treatment With PAR-1 Agents to Decrease Hemorrhagic Transformation

“…In a recent study, Li et al ( 42 ) evaluated the prevalence of previous chronic cerebral hemorrhage, especially asymptomatic cases, and the associated factors in patients who experienced an acute ischemic stroke. Overall, 9.4% of patients were determined to have had a previous chronic cerebral hemorrhage, with almost half of these being asymptomatic, indicating that previous chronic cerebral hemorrhage is not uncommon in acute ischemic stroke patients.…”