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We studied the mechanism of hemorrhagic infarction after acute cerebral embolism in 160 patients by brain computed tomography and angiography. Hemorrhagic infarction during the month after the embolic event was evident in 65 patients(40.6%).Initial angiography a median of 1.5(range 1- 60)days after the event revealed occlusion of the cerebral arteries in 117 of 142 patients(82.4%),and reopening of the vessels was observed in 56(94. 9%)of 59 patients who had follow-up angiography a median of 20(range 3-47) days after the event.The incidence of hemorrhagic infarction was higher in patients greater than or equal to 70 years old(31 of 61,50.8%)than in those aged 50-69(27 of 72,37.5%)or<50 years(seven of 27,25.9%)(greater than or equal to 70 vs<50,p<0.05).In patients with moderate or large infarcts,hemorrhagic infarction developed in 50.0%or 51.5%,respectively, while in those with small infarcts it developed in only 2.9%(p<0.05).No correlation was found between hemorrhagic infarction and history of hypertension or blood pressure during the acute stage of stroke. Thrombolytic and/or anticoagulant therapy did not affect the incidence of hemorrhagic infarction(40.0%with vs.40.7%without therapy)but tended to cause massive hematoma.Our results indicate that hemorrhagic transformation in cerebral embolism is caused not only by reopening of the occluded vessels but also by other factors such as age and size of the infarct.Hypertension per se seems to be less important for hemorrhagic infarction.Anticoagulants and/or thrombolytic agents should be carefully administered in the elderly and in patients with large infarcts. |
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angiography,cerebral
anticoagulant,complications of
anticoagulant,treatment
CAT scan
CAT scan,abnormal
cerebral embolism
cerebral embolism,cardiac origin
cerebral infarction,hemorrhagic
embolism
intracerebral hemorrhage
old age,neurology of
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