PREDICTIVE FACTORS OF HEMORRHAGIC ISCHEMIC STROKE DETECTED BY CT AND MRI GRADIENT-ECHO T2 WEIGHTED IMAGE (GRE)

Abstract

Background: Risk of hemorrhage is significantly increased in large infarcts, with mass effect supporting the importance of edema for tissue damage and the deleterious effect of late reperfusion when edema resolves. In some instances, the rupture of the vascular wall secondary to ischemia-induced endothelial necrosis might cause an intra-infarct hematoma. Vascular rupture can explain very early hemorrhagic infarcts and early intra infarct hematoma (between 6 and 18 hours after stroke), whereas hemorrhagic transformation usually develops within 48 hours to 2 weeks. Intra cerebral hemorrhage (ICH) occurs as a result of bleeding from an arterial source directly into the brain parenchyma and accounts for 5–15% of all strokes. Objective: The aim of this study was to determine the predictive factors of hemorrhagic transformation in patient with acute ischemic stroke detected by brain CT and MRI gradient echo T2 weighted image (GRE). Patients and Methods: This was a cross sectional randomized prospective study carried out on 60 patients (32 males and 28 females), admitted at Neurology Department and Stroke Unit of Mostafa Kamel Military Hospital, within the first 24 hours of their symptoms. The study was carried out during the period from 1st of January 2018 till the end of December 2018. Results: The results of this study showed that the size of infarction was small in 27 (45.0%) patients and large in 33 (55.0%) patients, the micro bleeds were found in 32 (53.3%) of the studied patients, and the hemorrhagic transformation was found in 11 (18.3%) of the patients. The results showed that there was a significant relation between micro bleeds and hypertension, diabetes mellitus, dyslipidemia, past history of stroke, cardiac disease and hemorrhagic transformation. The small size infarction showed a higher percent of micro bleeds. Regarding the hemorrhagic transformation, the risk factors were the size of infarction, anticoagulant use, hypertension, diabetic and cardiac diseases. Conclusion: The most predictive factors of hemorrhagic transformation was the size of infarction (higher in large), micro bleed, anticoagulant use, hypertension, dyslipidemia and cardiac disease, while the most predictive factors of micro bleeds were the size of infarction (higher in small), age, hypertension, dyslipidemia, past history of stroke, diabetes mellitus, and cardiac disease.