title: Massive haemorrhagic transformation in cardioembolic stroke: the role of arterial wall trauma and dissection.
abstract: The pathogenesis of massive haemorrhagic transformation is not well established. Fatal haemorrhagic transformation associated with in situ dissection after acute middle cerebral artery (MCA) occlusion in a patient with atrial fibrillation is reported. An 80 year old woman with atrial fibrillation developed mild hemiparesis and aphasia. Brain CT and MRI at 4 and 5 hours, respectively, of symptom onset showed proximal MCA trunk occlusion with developing striatocapsular infarct and hypoperfusion in the superficial MCA territory. A few hours later, she developed massive bleeding into the ischaemic area and died. Pathological examination showed MCA trunk dissection, surrounded by a subarachnoid clot which communicated with the cerebral haematoma. It is suggested that direct arterial wall trauma as a result of cardioembolic MCA occlusion caused bleeding into the infarct. Secondary in situ dissection may be an overlooked mechanism of haemorrhagic transformation.
authors: Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors: G R
authors: GR
authors: de Freitas
authors: A
authors: A
authors: Carruzzo
authors: A
authors: A
authors: Tsiskaridze
authors: J A
authors: JA
authors: Lobrinus
authors: J
authors: J
authors: Bogousslavsky
mesh_terms: D000368:Aged; D001158:Arteries / Q000503:physiopathology*; D001281:Atrial Fibrillation / Q000503:physiopathology*; D005260:Female; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000473:pathology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D020521:Stroke / Q000473:pathology*