PURPOSE: To determine the incidence, appearance, and clinical significance of lesions mimicking intraparenchymal hemorrhages on CT in patients treated with intracranial intraarterial thrombolysis for acute strokes. METHODS: Ten cases of acute stroke treated with direct intraarterial urokinase infusion were retrospectively reviewed. Clinical and radiographic findings before and after therapy were all evaluated. RESULTS: Six (60%) of the 10 patients showed areas of increased attenuation on CT shortly after thrombolytic therapy. The lesions were associated with clinical deterioration in two cases (20%); in these two cases the lesions persisted on CT for several days. The lesions were asymptomatic in two (20%) cases; the lesions cleared on CT within 24 hours in those two patients. In two (20%) patients, immediate clinical improvement was evident despite the radiodense areas. These lesions also cleared within 24 hours. CT Hounsfield unit measurements of four of the lesions revealed very high Hounsfield units in two lesions, only one of which was a symptomatic lesion. MR in two cases revealed residue of hemorrhage. CONCLUSION: Intraparenchymal areas of increased attenuation may be seen on the CT scans of patients after intraarterial thrombolysis. The density is often at least partially attributable to contrast extravasation. The lesions should not necessarily be interpreted as hemorrhage alone, especially in the absence of clinical deterioration. Rapid clearing may be a positive prognostic sign.
PURPOSE: To determine the incidence, appearance, and clinical significance of lesions mimicking intraparenchymal hemorrhages on CT in patients treated with intracranial intraarterial thrombolysis for acute strokes. METHODS: Ten cases of acute stroke treated with direct intraarterial urokinase infusion were retrospectively reviewed. Clinical and radiographic findings before and after therapy were all evaluated. RESULTS: Six (60%) of the 10 patients showed areas of increased attenuation on CT shortly after thrombolytic therapy. The lesions were associated with clinical deterioration in two cases (20%); in these two cases the lesions persisted on CT for several days. The lesions were asymptomatic in two (20%) cases; the lesions cleared on CT within 24 hours in those two patients. In two (20%) patients, immediate clinical improvement was evident despite the radiodense areas. These lesions also cleared within 24 hours. CT Hounsfield unit measurements of four of the lesions revealed very high Hounsfield units in two lesions, only one of which was a symptomatic lesion. MR in two cases revealed residue of hemorrhage. CONCLUSION: Intraparenchymal areas of increased attenuation may be seen on the CT scans of patients after intraarterial thrombolysis. The density is often at least partially attributable to contrast extravasation. The lesions should not necessarily be interpreted as hemorrhage alone, especially in the absence of clinical deterioration. Rapid clearing may be a positive prognostic sign.
Authors: G Parrilla; B García-Villalba; M Espinosa de Rueda; J Zamarro; E Carrión; F Hernández-Fernández; J Martín; R Hernández-Clares; A Morales; A Moreno Journal: AJNR Am J Neuroradiol Date: 2012-04-26 Impact factor: 3.825
Authors: S Mangiafico; M Cellerini; G Villa; M Nistri; C Pandolfo; F Ammannati; P Mennonna; G P Giordano Journal: Interv Neuroradiol Date: 2004-10-20 Impact factor: 1.610
Authors: Yuko Kurosawa; Aigang Lu; Pooja Khatri; Janice A Carrozzella; Joseph F Clark; Jane Khoury; Thomas A Tomsick Journal: Stroke Date: 2010-04-01 Impact factor: 7.914
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
Authors: Tobias Struffert; Martin Köhrmann; Tobias Engelhorn; Tim Nowe; Gregor Richter; Peter D Schellinger; Stefan Schwab; Arnd Doerfler Journal: Eur Radiol Date: 2009-04-07 Impact factor: 5.315