This is a descriptive study about hyperdensities on post-treatment CT of intraarterial thrombolysis in patients with ischemic stroke to make a correct differential diagnosis between cerebral hemorrhage and extravasation of contrast.
Methods and Materials
Three patients diagnosed with ischemic stroke underwent arterial thrombolysis,
which was performed within 12-24 hours.
CT hyperdensities presented in the basal ganglia were monitored for control.
Then the patients were assessed for the clinical significance of areas of CT hyperdensity seen post-treatment.
Patient 1: 79-year-old woman admitted for rightmiddle cerebral artery stroke of cardioembolic origin,
possible chronic atrial fibrillation: treated with acenocoumarol.
The CT scan (Figure 1) and subsequently arterial thrombolysis.
Patient 2: 55-year-old male who presents with symptoms compatible with right middle cerebral arterystroke...
The presence of hyperdensities on CT after intraarterial thrombolysis is not always bleeding,
because there may be extravasation of contrast. However,
this may suggest some degree of microvascular damage and may predict the onset of further bleeding complications.
In the three cases reported,
two of them showed extravasation and the other cerebral hemorrhage.
PATIENT 1: At 17 hours,
thrombolysis was performed.
CT showed right basal ganglia hyperdensity,
poorly defined (Figure 9).
This hyperdensity was practically resolved on the control CT performed after 48 hours,
Although more than half of the CT hyperdensities after arterial thrombolysis are associated with a certain degree of microvascular damage from bleeding,
only 1/3 present with symptomatic hemorrhage.
If the damage only affects vascular endothelial cells,
hyperdense areas could be contrast medium,
but if the damage is more extensive and affects basal lamina as hyperdense areas,
this may be associated with some degree of bleeding.
The lenticular nuclei hyperdensities can develop into a massive hemorrhage.
When located in the cerebral cortex,
this represents a high...
The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group.
Tissue plasminogen activator for acute ischaemic stroke.
N Engl J Med.
Trombolysis with alteplase for acute ischaemic stroke the Safe Implementation of Thrombolysis in Stroke-Monitoring study (SITS-MOST): An observational study.
for the MRI in Acute Stroke Study Group of the...