title: Impact of leukoaraiosis on parenchymal hemorrhage in elderly patients treated with thrombolysis.
abstract: BACKGROUND
  Severity of vascular damage of white matter may predict hemorrhagic transformation (HT). We assess the relationship between leukoaraiosis (LA) severity and the type of hemorrhagic transformation in elderly patients treated with thrombolysis.
  
  
  METHODS
  We retrospectively analyzed the clinical data and pretreatment magnetic resonance imaging (MRI) of 180 consecutive ischemic stroke patients aged over 75 years. LA severity was graded according to the Fazekas scale, and acute diffusion-weighted-imaging (DWI) lesion volumes were semi-automatically outlined. Predictors of hemorrhagic infarction (HI) and parenchymal hemorrhage (PH) were identified using logistic regression analysis and exact multinomial logistic analysis.
  
  
  RESULTS
  HT occurred in 31 patients (17 %). Baseline National Institute of Health Stroke Score (NIHSS; p = 0.008), severe LA (p = 0.02), and diffusion lesion volume (p = 0.02) were predictors of HT in univariable logistic regression. Adjusted to lesion volume and baseline NIHSS score, exact multinomial logistic analysis showed that severe LA was the only independent predictor of parenchymal hemorrhage (p = 0.03).
  
  
  CONCLUSIONS
  In elderly patients, LA severity better predicts parenchymal hemorrhage than infarct size.
authors.affiliation: Department of Stroke, Neurological Hospital, Université Lyon 1, Lyon, France.
authors.forename: Norbert
authors.initials: N
authors.lastname: Nighoghossian
authors.affiliation: Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France.
authors.forename: Fatima
authors.initials: F
authors.lastname: Abbas
authors.affiliation: Department of Stroke, Neurological Hospital, Université Lyon 1, Lyon, France.
authors.forename: Tae-Hee
authors.initials: TH
authors.lastname: Cho
authors.affiliation: Department of Neuroradiology, Neurological Hospital, Université Lyon 1, 59 Bd Pinel, 69677, Bron, Lyon, France.
authors.forename: Ana Filipa
authors.initials: AF
authors.lastname: Geraldo
authors.affiliation: Department of Stroke, Neurological Hospital, Université Lyon 1, Lyon, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Cottaz
authors.affiliation: Department of Neuroradiology, Neurological Hospital, Université Lyon 1, 59 Bd Pinel, 69677, Bron, Lyon, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Janecek
authors.affiliation: Department of Stroke, Neurological Hospital, Université Lyon 1, Lyon, France.
authors.forename: Laura
authors.initials: L
authors.lastname: Mechtouff
authors.affiliation: RESUVAL Stroke Network, Lyon, France.
authors.forename: Magali
authors.initials: M
authors.lastname: Bischoff
authors.affiliation: RESUVAL Stroke Network, Lyon, France.
authors.forename: Carlos
authors.initials: C
authors.lastname: El Khoury
authors.affiliation: Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Schott
authors.affiliation: Department of Stroke, Neurological Hospital, Université Lyon 1, Lyon, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Derex
authors.affiliation: Department of Neuroradiology, Neurological Hospital, Université Lyon 1, 59 Bd Pinel, 69677, Bron, Lyon, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Hermier
authors.affiliation: Department of Neuroradiology, Neurological Hospital, Université Lyon 1, 59 Bd Pinel, 69677, Bron, Lyon, France.
authors.forename: Louis Guy
authors.initials: LG
authors.lastname: Tisserand
authors.affiliation: Department of Neuroradiology, Neurological Hospital, Université Lyon 1, 59 Bd Pinel, 69677, Bron, Lyon, France.
authors.forename: Roxana
authors.initials: R
authors.lastname: Amelie
authors.affiliation: Department of Neuroradiology, Neurological Hospital, Université Lyon 1, 59 Bd Pinel, 69677, Bron, Lyon, France.
authors.forename: Leila
authors.initials: L
authors.lastname: Chamard
authors.affiliation: Department of Neuroradiology, Neurological Hospital, Université Lyon 1, 59 Bd Pinel, 69677, Bron, Lyon, France. yves.berthezene@chu-lyon.fr.
authors.forename: Yves
authors.initials: Y
authors.lastname: Berthezene
mesh_terms: D000369:Aged, 80 and over; D015984:Causality; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy*; D015897:Comorbidity; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D049292:Leukoaraiosis / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000517:prevention & control; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: Elderly; Ischemic stroke; Leucoaraiosis; Magnetic resonance imaging; Thrombolysis