title: Haemorrhagic transformation of ischaemic stroke in young adults.
abstract: BACKGROUND
  Frequency, factors associated with, and impact on outcome of haemorrhagic transformation in young adults with ischaemic stroke are unknown.
  
  
  METHODS
  Consecutive young patients (age 15-49) with first-ever ischaemic stroke were included, having their first brain computed tomography/magnetic resonance imaging within seven-days of stroke onset, and second within seven-days from the first imaging. Haemorrhagic transformation in any imaging was classified as haemorrhagic infarct or parenchymal haemorrhage within or remote from the infarct. Symptomatic haemorrhagic transformation was defined according to the European Cooperative Acute Stroke Study II (ECASS II) criteria as any haemorrhage leading to a National Institutes of Health Stroke Scale score increase of ≥4 points or death. Unfavourable three-month outcome was defined as a modified Rankin Scale 2-6.
  
  
  RESULTS
  In 636 eligible patients, any haemorrhagic transformation occurred in 79 patients (12·4%; 10·0-15·2%): 66 (10·4%; 8·24-12·9%) had haemorrhagic infarct, and 13 (2·04%; 1·19-3·46%) had parenchymal haemorrhage. Symptomatic haemorrhagic transformation occurred in 16 patients (2·5%; 4·04-1·55%). In logistic regression analysis, independent factors associated with haemorrhagic transformation were large anterior (18·70; 6·72-52·04), large posterior (9·41; 3·13-28·25), medium-sized (odds ratio 3·30; 95% confidence interval 1·14-9·57) lesions, higher low-density lipoprotein level (1·44 per unit increment; 1·10-1·90), and lower platelet count (1·005 per unit decrement; 1·009-1·001). Haemorrhagic infarct (1·76; 0·76-4·11) or parenchymal haemorrhage (2·39; 0·23-24·76) were not associated with unfavourable functional outcome or death at three-months.
  
  
  CONCLUSIONS
  In young adults, haemorrhagic transformation of ischaemic stroke occurred in comparable rates to haemorrhagic transformation in elderly patients. Although haemorrhagic transformation was more common in severe strokes, it was the lesion size and baseline stroke severity that were associated with three-month clinical outcome, not haemorrhagic transformation per se.
authors.affiliation: Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Satu
authors.initials: S
authors.lastname: Mustanoja
authors.forename: Elena
authors.initials: E
authors.lastname: Haapaniemi
authors.forename: Jukka
authors.initials: J
authors.lastname: Putaala
authors.forename: Daniel
authors.initials: D
authors.lastname: Strbian
authors.forename: Markku
authors.initials: M
authors.lastname: Kaste
authors.forename: Turgut
authors.initials: T
authors.lastname: Tatlisumak
mesh_terms: D000328:Adult; D000367:Age Factors; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D054893:Cone-Beam Computed Tomography; D018450:Disease Progression; D005260:Female; D006801:Humans; D007511:Ischemia / Q000150:complications; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000209:etiology