Focal fluid-attenuated inversion recovery hyperintensity within acute diffusion-weighted imaging lesions is associated with symptomatic intracerebral hemorrhage after thrombolysis.
OBJECTIVE
We investigated whether focal hyperintensity on fluid-attenuated inversion recovery image within acute infarcts is associated with symptomatic intracerebral hemorrhage (SICH) after thrombolysis.


METHODS
Patients with acute ischemic stroke who underwent MRI screening before thrombolysis were enrolled. The presence of focal fluid-attenuated inversion recovery hyperintensity within acute infarcts did not preclude thrombolysis. SICH was defined as hemorrhagic transformation with any neurological decline (SICH-1) or with an increase in National Institutes of Health Stroke Scale of >or=4 (SICH-2) within 48 hours.


RESULTS
Among 88 included patients, focal fluid-attenuated inversion recovery hyperintensity within acute infarct lesions was observed in 27 (30.7%) patients. Multivariate analysis showed that focal fluid-attenuated inversion recovery hyperintensity was independently associated with SICH-1 (OR, 13.64; 95% CI, 1.51 to 123.28) and SICH-2 (OR, 10.44; 95% CI, 1.11 to 98.35).


CONCLUSIONS
The presence of focal fluid-attenuated inversion recovery hyperintensity within acute infarcts may increase the risk of symptomatic intracerebral hemorrhage after thrombolysis.
Cho
A-Hyun
AH
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, South Korea.
Kim
Jong S
JS
Kim
Sang-Joon
SJ
Yun
Sung-Cheol
SC
Choi
Choong-Gon
CG
Kim
Hyoung-Ryoul
HR
Kwon
Sun U
SU
Lee
Deok-Hee
DH
Kim
Eun-Kyung
EK
Suh
Dae-Chul
DC
Kang
Dong-Wha
DW
D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000473:pathology / Q000517:prevention & control*; D038524:Diffusion Magnetic Resonance Imaging; D004198:Disease Susceptibility; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007261:Infusions, Intra-Arterial; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator