title: Haemorrhagic transformation in ischaemic stroke is more frequent than clinically suspected - A neuropathological study.
abstract: OBJECTIVE
  The vast majority of literature on the frequency of the haemorrhagic transformation of ischaemic stroke is based on imaging studies. The purpose of the present study was to assess the added value of autopsy and neuropathological analysis in a neurology centre with emphasis on acute stroke care.
  
  
  METHODS
  We retrospectively analysed the findings of 100 consecutive brain autopsies followed by detailed clinical correlation.
  
  
  RESULTS
  The clinical diagnosis was confirmed by neuropathology in every patient with intracerebral haemorrhage and with non-cerebrovascular neurological disorders (e.g. primary tumours, metastases, infections). At admission 64 patients (age 62years, SD 6.5) were diagnosed with acute ischaemic stroke. In 10 of these patients (16%) haemorrhagic transformation was diagnosed clinically by a second CT. In 24 cases (38%) haemorrhagic transformation was detected only at autopsy. The distribution of haemorrhagic transformation in our material was the following: small petechiae in 26.5%, more confluent petechiae in 29.4%, ≤30% of the infarcted area with some mild space-occupying effect in 29.4% and >30% of the infarcted area with significant space-occupying effect or clot remote from infarcted area in 14.7%. Most of the PH1-2 transformations developed in thrombolysed patients and all of the PH2 type transformations were diagnosed already clinically.
  
  
  CONCLUSIONS
  We demonstrated that haemorrhagic transformation is frequent and often undiscovered in vivo. Our findings underline the importance of post-mortem neuropathological examination also in the era of advanced imaging techniques and prove that autopsy is the ultimate yardstick of our diagnostic and therapeutic efforts. The high number of haemorrhagic transformations diagnosed only after death is an important novel finding with clinical implications.
authors.affiliation: Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
authors.forename: Rita
authors.initials: R
authors.lastname: Szepesi
authors.affiliation: Division of Neuropathology, Institute of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
authors.forename: Ákos
authors.initials: Á
authors.lastname: Csokonay
authors.affiliation: Division of Neuropathology, Institute of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
authors.forename: Balázs
authors.initials: B
authors.lastname: Murnyák
authors.affiliation: Division of Neuropathology, Institute of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
authors.forename: Mahan C
authors.initials: MC
authors.lastname: Kouhsari
authors.affiliation: Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
authors.forename: Gergely
authors.initials: G
authors.lastname: Hofgárt
authors.affiliation: Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
authors.forename: László
authors.initials: L
authors.lastname: Csiba
authors.affiliation: Division of Neuropathology, Institute of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary. Electronic address: hortobagyi@med.unideb.hu.
authors.forename: Tibor
authors.initials: T
authors.lastname: Hortobágyi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed
keywords: Autopsy; Haemorrhagic transformation; Neuropathology; Stroke