Hyperintense acute reperfusion marker on FLAIR is not associated with early haemorrhagic transformation in the elderly.
OBJECTIVE
The hyperintense acute reperfusion marker (HARM) has been described as a predictor for haemorrhagic transformation (HT) in acute ischaemic stroke. We hypothesised that this phenomenon is not present in the elderly.


METHODS
It was possible to assess 47/84 consecutive patients aged 80 and over with diagnosed ischaemic stroke or transient ischaemic attack (TIA). MRI was performed within 24 h of onset of symptoms with follow-up MRI within a further 48 h.


RESULTS
Of 47 included patients, 19 showed HARM; it was only seen on follow-up examination. Ten of the 47 patients underwent thrombolysis with recombinant tissue plasminogen activator (rt-PA); 4 of them showed HARM, and 1 of those showed HT. HARM was found in three out of eight patients with haemorrhagic transformation on baseline and/or follow-up MRI. We did not observe an association between HARM and early HT either in the whole group or in the patients who received thrombolysis.


CONCLUSIONS
HARM was not associated with HT in the elderly after ischaemic stroke, independent of treatment. While it may indicate dysfunction of the blood-brain barrier (BBB), it does not necessarily amount to HT.
Rozanski
Michal
M
Department of Neurology, Center for Stroke Research Berlin-CSB, Charité, Universitätsmedizin Berlin, Berlin, Germany. michal.rozanski@charite.de
Ebinger
Martin
M
Schmidt
Wolf U
WU
Hotter
Benjamin
B
Pittl
Sandra
S
Heuschmann
Peter U
PU
Jungehuelsing
Jan G
JG
Fiebach
Jochen B
JB
D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000209:etiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015427:Reperfusion Injury / Q000209:etiology* / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity