title: Risk Factors for Hemorrhagic Transformation in Patients with Acute Middle Cerebral Artery Infarction.
abstract: BACKGROUND
  Hemorrhagic transformation (HT) after acute ischemic stroke (AIS) can be seen at any time following ischemic stroke. Although HT usually occurs as a complication of antithrombotic, anticoagulant, or thrombolytic treatments, it can also occur spontaneously. We aimed to investigate the occurrence of early HT and its relevant risk factors in patients diagnosed with acute middle cerebral artery (MCA) infarction who were not treated with thrombolytic agents.
  
  
  METHODS
  We recruited 171 patients with acute MCA infarction between January 2011 and July 2012 who were not treated with thrombolytic agents and were suitable to our inclusion criteria. Controlled neuroimaging was performed immediately in patients with deterioration, otherwise on day 7 following stroke. All patients were investigated for AIS risk factors and biochemical analyses were performed. Patients with HT in controlled neuroimaging were grouped both clinically (i.e., symptomatic or asymptomatic) and radiologically, according to "European Cooperative Acute Stroke Radiological Study" (ECASS), and risk factors were examined.
  
  
  RESULTS
  We enrolled 171 patients [94 men (55%) and 77 women (45%)] in the study. HT developed in 37 patients (21.63%). In terms of risk factor analysis, the most frequent etiological factor was atherosclerosis in AIS patients (50.3%). National Institutes of Health Stroke Scale scores were significantly higher both in sHT patients according to asHT patients and in HT patients on day 7 compared with their initial scores. Serum low-density lipoprotein (LDL-C), triglycerides (TG), and total cholesterol (TC) levels were significantly lower in patients with HT (p<.001).
  
  
  CONCLUSIONS
  HT is a major complication in AIS that considerably increases the morbidity and mortality. To reduce the occurrence of HT, risk factors for each patient population should be determined. Acute thrombolytic therapy should be used cautiously in high-risk patients, and appropriate alternative therapies should be revised in them.
authors.affiliation: Clinic of Neurology, İzmir Tepecik Training and Research Hospital, İzmir, Turkey.
authors.forename: Levent
authors.initials: L
authors.lastname: Öcek
authors.affiliation: Clinic of Neurology, İzmir Tepecik Training and Research Hospital, İzmir, Turkey.
authors.forename: Derya
authors.initials: D
authors.lastname: Güner
authors.affiliation: Clinic of Neurology, İzmir Tepecik Training and Research Hospital, İzmir, Turkey.
authors.forename: İrem Fatma
authors.initials: İF
authors.lastname: Uludağ
authors.affiliation: Clinic of Neurology, İzmir Tepecik Training and Research Hospital, İzmir, Turkey.
authors.forename: Bedile İrem
authors.initials: Bİ
authors.lastname: Tiftikçioğlu
authors.affiliation: Clinic of Neurology, İzmir Tepecik Training and Research Hospital, İzmir, Turkey.
authors.forename: Yaşar
authors.initials: Y
authors.lastname: Zorlu
keywords: Acute ischemic stroke; hemorrhagic transformation; middle cerebral artery infarction