Hemorrhagic transformation
| Hemorrhagic transformation | |
|---|---|
| Specialty | Neurology |
| Usual onset | In majority seen within 4 days of initial stroke. In patients treated with thrombolysis - within 24 hours.[1][2] |
| Types | petechial hemorrhage, parenchymal hemorrhage |
| Diagnostic method | Brain computed tomography (CT) angiography |
Hemorrhagic transformation (HT) or hemorrhagic conversion is a medical complication that can occur in the brain following an acute ischemic stroke, a condition in which blood flow to the brain is blocked.[3]
Hemorrhagic transformation is a process which involves the bleeding of brain tissue that has been affected by the stroke and can take two forms: petechial hemorrhage and parenchymal hemorrhage.[1]
HT can lead to further damage to the brain tissue and worsen the outcome of the initial stroke. The risk of HT increases with the severity and duration of the initial stroke, as well as with certain medical conditions such as high blood pressure, diabetes, and clotting disorders[3] and the use of certain medications, such as anticoagulants and thrombolytic tpA medication (such as alteplase) which can increase the bleeding risk.[4][5]
Effective treatment is complex and may involve medications to control bleeding (reversing coagulopathy), management of underlying medical conditions, and sometimes neurosurgical treatment to reduce the bleeding.[6][7]
Signs and symptoms
Signs and symptoms can vary depending on the severity and location of the bleeding within the brain tissue.
In the medical literature, various criteria have been used to establish whether a hemorrhagic infarction is symptomatic or not. Studies have shown that only parenchymal hematomas are strongly associated with long-term deterioration and worsening of the patient's condition. Most cases of hemorrhagic transformation, including the majority of petechial hemorrhages, are asymptomatic and do not cause noticeable symptoms.[6]
Some common symptoms might include:[8]
- Headache
- Changes in consciousness
- Weakness or numbness
- Seizures
- Speech difficulties
- Vision problems
Pathophysiology
HT involves the extravasation of blood from the peripheral circulation across a disrupted blood-brain barrier (BBB) and into the brain tissue.[3]
Epidemiology
Around 10-15% of patients with acute ischemic stroke experience hemorrhagic transformation.[7]
References
- ^ a b Gaillard F. "Hemorrhagic transformation of ischemic infarct". Radiology Reference Article. Radiopaedia. Retrieved 2023-02-28.
- ^ The NINDS t-PA Stroke Study Group (November 1997). "Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke". Stroke. 28 (11): 2109–18. doi:10.1161/01.str.28.11.2109. PMID 9368550.
- ^ a b c Spronk E, Sykes G, Falcione S, Munsterman D, Joy T, Kamtchum-Tatuene J, Jickling GC (2021). "Hemorrhagic Transformation in Ischemic Stroke and the Role of Inflammation". Frontiers in Neurology. 12: 661955. doi:10.3389/fneur.2021.661955. PMC 8160112. PMID 34054705.
- ^ Marsh EB, Llinas RH, Schneider AL, Hillis AE, Lawrence E, Dziedzic P, Gottesman RF (January 2016). "Predicting Hemorrhagic Transformation of Acute Ischemic Stroke: Prospective Validation of the HeRS Score". Medicine. 95 (2): e2430. doi:10.1097/MD.0000000000002430. PMC 4718251. PMID 26765425.
- ^ Yaghi S, Willey JZ, Cucchiara B, Goldstein JN, Gonzales NR, Khatri P, et al. (December 2017). "Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association". Stroke. 48 (12): e343–e361. doi:10.1161/STR.0000000000000152. PMID 29097489. S2CID 3779945.
- ^ a b Hong JM, Kim DS, Kim M (2021). "Hemorrhagic Transformation After Ischemic Stroke: Mechanisms and Management". Frontiers in Neurology. 12: 703258. doi:10.3389/fneur.2021.703258. PMC 8669478. PMID 34917010.
- ^ a b Stone JA, Willey JZ, Keyrouz S, Butera J, McTaggart RA, Cutting S, et al. (January 2017). "Therapies for Hemorrhagic Transformation in Acute Ischemic Stroke". Current Treatment Options in Neurology. 19 (1): 1. doi:10.1007/s11940-017-0438-5. PMID 28130682. S2CID 3294843.
- ^ Unnithan AK, Das J, Mehta P (2022). "Hemorrhagic Stroke". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 32644599. Retrieved 2023-02-28.