Hemorrhagic transformation in cardioembolic cerebral infarction.
OBJECTIVE
Because the frequency of hemorrhagic transformation of cerebral infarcts is still a matter of controversy, we performed a prospective magnetic resonance imaging study in a series of consecutive patients with cardioembolic stroke.


RESULTS
Among 200 consecutive patients with transient ischemic attack or ischemic stroke, 41 were identified with a computed tomographically proven supratentorial infarct due to cardiogenic embolism. Magnetic resonance imaging (T1-weighted) was performed 3 weeks after the stroke in 35 of these 41 patients. Eight patients received anticoagulants. Magnetic resonance images showed hemorrhagic transformation in 68.6% (24) of the 35 infarcts, always without clinical deterioration. In a stepwise forward logistic regression analysis only the volume of infarction edema on the initial computed tomogram was linked significantly with the risk of hemorrhagic transformation (p = 0.037). Hemorrhages were a regular finding on magnetic resonance images of infarcts exceeding a volume of 10 cm3 (94.4%, 17 of 18).


CONCLUSIONS
Hemorrhagic transformation is a regular finding in medium-sized and large cardioembolic infarcts. Thus, in therapeutic and preventive studies of acute stroke the severity, not the frequency, of hemorrhages into brain infarcts should be the matter of interest.
Hornig
C R
CR
Department of Neurology, Justus Liebig University, Giessen, FRG.
Bauer
T
T
Simon
C
C
Trittmacher
S
S
Dorndorf
W
W
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000209:etiology; D009202:Cardiomyopathies / Q000150:complications; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications; D011859:Radiography