Remote cerebral hematomas in patients treated with intravenous rt-PA.
The frequency, clinical presentation, radiological features, and prognosis of remote cerebral hematomas (rPH) are not well known. We report our experience in patients treated with intravenous rt-PA. We reviewed our database of consecutive patients treated at our hospital from 1999 to 2008. We used the inclusion/exclusion criteria of the ECASS-2 study from 1999 to 2003, and the criteria of the SITS-MOST study since 2004. A follow-up CT scan was obtained in all of the patients within the first 36 h of treatment. Cerebral hemorrhagic complications were classified as hemorrhagic infarction (HI-1/HI-2) and parenchymal hematoma (PH-1/PH-2). The rPH was defined as any extra-ischemic hemorrhagic lesion observed in the follow-up CT. A favorable outcome was defined as a score 0-1 on the Rankin scale at 3 months. We treated 210 patients (mean age 67.6 +/- 12.4 years, 56% were men). The median initial NIHSS score was 14. Patients with rPH (n = 7) had a mean age of 72.4 +/- 7.5 years and 43% were men. The median initial NIHSS score was 15. Three patients had multifocal rPH; three patients had a single rPH and in one patient the rPH was associated with a PH-2. rPH were lobar in six patients and in brainstem in one patient, symptomatic in five patients and asymptomatic in two patients. The outcome was unfavorable in all of them; four deaths (57%) were recorded. Remote cerebral hemorrhage is an infrequent complication after rt-PA treatment (3.3%), it is usually lobar and symptomatic and has an uniformly unfavorable outcome.
Department of Neurology, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret, Barcelona, Spain. emartinezh@santpau.cat
Eugenia
E
Martínez-Hernández
Sergi
S
Martínez-Ramírez
Raquel
R
Delgado-Mederos
Daniel
D
Alcolea
Marta
M
Marquié
Rebeca
R
Marín
Manuel
M
De Juan
Josep Lluis
JL
Martí-Vilalta
Joan
J
Martí-Fàbregas
D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D002536:Cerebral Arteries / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000503:physiopathology; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D007049:Iatrogenic Disease / Q000517:prevention & control; D007262:Infusions, Intravenous; D020767:Intracranial Thrombosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects* / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects*
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator