BACKGROUND AND PURPOSE: The term symptomatic hemorrhage secondary to ischemic stroke implies a clear causal relationship between clinical deterioration and hemorrhagic transformation (HT) regardless of the type of HT. The aim of this study was to assess which type of HT independently affects clinical outcome. METHODS: We used the data set of the European Cooperative Acute Stroke Study (ECASS) II for a post hoc analysis. All patients had a control CT scan after 24 to 96 hours or earlier in case of rapid and severe clinical deterioration. HT was categorized according to radiological criteria: hemorrhagic infarction type 1 and type 2 and parenchymal hematoma type 1 and type 2. The clinical course was prospectively documented with the National Institutes of Health Stroke Scale and the modified Rankin Scale: The independent risk of each type of HT was calculated for clinical deterioration at 24 hours and disability and death at 3 months after stroke onset and adjusted for possible confounding factors such as age, severity of stroke syndrome at baseline, and extent of the ischemic lesion on the initial CT. RESULTS: Compared with absence of HT, only parenchymal hematoma type 2 was associated with an increased risk for deterioration at 24 hours after stroke onset (adjusted odds ratio, 18; 95% CI, 6 to 56) and for death at 3 months (adjusted odds ratio, 11; 95% CI, 3.7 to 36). All other types of HT did not independently increase the risk of late deterioration. CONCLUSIONS: Only parenchymal hematoma type 2 independently causes clinical deterioration and impairs prognosis. It has a distinct radiological feature: it is a dense homogeneous hematoma >30% of the ischemic lesion volume with significant space-occupying effect.
BACKGROUND AND PURPOSE: The term symptomatic hemorrhage secondary to ischemic stroke implies a clear causal relationship between clinical deterioration and hemorrhagic transformation (HT) regardless of the type of HT. The aim of this study was to assess which type of HT independently affects clinical outcome. METHODS: We used the data set of the European Cooperative Acute Stroke Study (ECASS) II for a post hoc analysis. All patients had a control CT scan after 24 to 96 hours or earlier in case of rapid and severe clinical deterioration. HT was categorized according to radiological criteria: hemorrhagic infarction type 1 and type 2 and parenchymal hematoma type 1 and type 2. The clinical course was prospectively documented with the National Institutes of Health Stroke Scale and the modified Rankin Scale: The independent risk of each type of HT was calculated for clinical deterioration at 24 hours and disability and death at 3 months after stroke onset and adjusted for possible confounding factors such as age, severity of stroke syndrome at baseline, and extent of the ischemic lesion on the initial CT. RESULTS: Compared with absence of HT, only parenchymal hematoma type 2 was associated with an increased risk for deterioration at 24 hours after stroke onset (adjusted odds ratio, 18; 95% CI, 6 to 56) and for death at 3 months (adjusted odds ratio, 11; 95% CI, 3.7 to 36). All other types of HT did not independently increase the risk of late deterioration. CONCLUSIONS: Only parenchymal hematoma type 2 independently causes clinical deterioration and impairs prognosis. It has a distinct radiological feature: it is a dense homogeneous hematoma >30% of the ischemic lesion volume with significant space-occupying effect.
Authors: Angelika Hoffmann; Jörg Bredno; Michael F Wendland; Nikita Derugin; Jason Hom; Tibor Schuster; Hua Su; Peter T Ohara; William L Young; Max Wintermark Journal: Stroke Date: 2011-06-02 Impact factor: 7.914
Authors: Michal Rozanski; Martin Ebinger; Wolf U Schmidt; Benjamin Hotter; Sandra Pittl; Peter U Heuschmann; Jan G Jungehuelsing; Jochen B Fiebach Journal: Eur Radiol Date: 2010-07-21 Impact factor: 5.315
Authors: Wolfgang G Kunz; Wieland H Sommer; Christopher Höhne; Matthias P Fabritius; Felix Schuler; Franziska Dorn; Ahmed E Othman; Felix G Meinel; Louisa von Baumgarten; Maximilian F Reiser; Birgit Ertl-Wagner; Kolja M Thierfelder Journal: J Cereb Blood Flow Metab Date: 2017-01-13 Impact factor: 6.200
Authors: M S Mouradian; A Senthilselvan; G Jickling; J A McCombe; D J Emery; N Dean; A Shuaib Journal: J Neurol Neurosurg Psychiatry Date: 2005-09 Impact factor: 10.154
Authors: Matthew R Amans; Daniel L Cooke; Maya Vella; Christopher F Dowd; Van V Halbach; Randall T Higashida; Steven W Hetts Journal: Interv Neuroradiol Date: 2014-02-10 Impact factor: 1.610