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Clinical profile of patients with cerebral infarction that evolved to hemorrhagic transformation.


Rizalina I So,
Loreto J Codamos

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Publication Information

Publication Type
Publication Sub Type
Journal Article, Original
Philippine Journal of Internal Medicine
Publication Date
September-October 2003


Background: Hemorrhagic transformation in ischemic strokes often occurs as a result of large infarcts. Early CT Scan may not allow the identification of large embolic infarcts that are destined to later undergo hemorrhagic transformation. Understanding the relationship between the incidence of hemorrhagic transformation of ischemic stroke, its risk factors and arterial distribution, and how these risk factors and etiology relate to prognosis after ischemic stroke will help in the design of acute stroke treatment and prevention programs. This study aims to determine the clinical profile of patients with acute cerebral infarction who develop hemorrhagic conversion Study Design: Retrospective, Case-Control Setting: St. Lukes Medical Center, a tertiary hospital Methodology: All medical records of patients who were admitted and diagnosed with ischemic stroke were reviewed and included in the study. Patients were categorized into two, those with cerebral infarction defined as presence of parenchymal hyperdensity on CT scan; and those who developed hemorrhagic transformation, defined as multiple small hyperdensities within a hypodense area compatible with an arterial territory on cranial CT. Clinical profile and CT scan findings of these patients were reviewed and analyzed. A standard database was constructed to record the following information: age, sex, hypertension, diabetes mellitus, atrial fibrillation, ischemic cardiovascular disease, hypercholesterolemia, history of previous ischemic stroke, and smoking. Location of the area of infarction and its arterial distribution, area involve in hemorrhagic transformation and its arterial distribution, and lastly, Doppler ultrasound flow studies results were also recorded. Statistical analysis using Students t-test and Chi-square test were used. A p value of 0.05 was considered statistically significant difference Results: Risk factors present among patients in the 2 groups which included hypertension, diabetes mellitus, history of previous ischemic stroke and smoking were not significant. Atrial fibrillation, ischemic heart disease and elevation of serum cholesterol showed a statistically significant difference between the 2 groups. Most of the infarcted areas were supplied by the middle cerebral artery. Majority of the hemorrhagic conversion was found in areas supplied by the anterior and middle cerebral arteries. Results of Carotid Duplex Scan showed no significant difference between the 2 groups. Comparison of the results of Transcranial Doppler Studies showed statistically significant difference between the two groups Conclusion: Atrial Fibrillation is a major risk factor in the evolution of an ischemic infarct to hemorrhagic transformation. Ischemic heart disease and elevated serum cholesterol are risk factors associated with a higher likelihood of hemorrhagic conversion. Territories of the middle cerebral artery plus the anterior cerebral artery are more likely to be affected in hemorrhagic transformation of an infarct. An abnormal transcranial Doppler ultrasonography is associated with hemorrhagic transformation of an infarct.

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