title: Blood pressure management and evolution of thrombolysis-associated intracerebral hemorrhage in acute ischemic stroke.
abstract: BACKGROUND
  There is limited knowledge on the radiographic features of thrombolysis-induced hemorrhage. The factors that influence early hematoma expansion have not been elucidated.
  
  
  METHODS
  Patients presenting with a symptomatic intracerebral hemorrhage (ICH) as a result of intravenous (IV) thrombolysis with tissue plasminogen activator (tPA) for acute ischemic stroke and had noncontrast computed tomographic (CT) scans of the head were included in this retrospective study. Calculation of hematoma volumes was obtained. Analysis of covariance was used to evaluate for the effect of baseline blood pressure (BP) on initial hematoma volume and further growth.
  
  
  RESULTS
  Of 267 patients who were treated with intravenous tPA for acute ischemic stroke at our facility between January 1, 2005 and December 31, 2009, 17 patients developed symptomatic ICH and were included in the final analysis. There was a positive correlation between baseline level of systolic BP after thrombolysis and initial hematoma volume (r = 0.46; P = .03) but not for the diastolic BP (r = 0.07; P = .40). There was a significant increase in mean hematoma volume expansion when comparing results between the first and second CT scans (median 9 hours, 22 minutes; 14.9 ± 19.6 cm(3) to 26.0 ± 26.7 cm(3); P = .04). There was also a negative association between the reduction of systolic BP and hematoma growth (r = -0.67; P = .02), but no correlation with change in diastolic BP (r = -0.22; P = .28).
  
  
  CONCLUSIONS
  Once diagnosed, thrombolysis-induced symptomatic ICH undergoes significant early expansion in size. Systolic BP may play a role in hematoma expansion.
authors.affiliation: Department of Neurology, State University of New York at Buffalo, Buffalo, New York14203 , USA. maximmokin@gmail.com
authors.forename: Maxim
authors.initials: M
authors.lastname: Mokin
authors.forename: Tareq
authors.initials: T
authors.lastname: Kass-Hout
authors.forename: Omar
authors.initials: O
authors.lastname: Kass-Hout
authors.forename: Robert
authors.initials: R
authors.lastname: Zivadinov
authors.forename: Bijal
authors.initials: B
authors.lastname: Mehta
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002545:Brain Ischemia / Q000188:drug therapy*; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006406:Hematoma / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy*; D013599:Systole; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
chemical_list: D000959:Antihypertensive Agents; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator