Haemorrhagic transformation in acute ischaemic stroke following thrombolysis therapy: classification, pathogenesis and risk factors

• Published in: Postgraduate medical journal Vol. 84; no. 993; pp. 361 - 367
• Main Authors: Thanvi, B R, Treadwell, S, Robinson, T
• Format: Journal Article
• Language: English
• Published: London The Fellowship of Postgraduate Medicine 01.07.2008; BMJ; Oxford University Press
• Subjects: acute stroke; Asymptomatic; Biological and medical sciences; Blood clots; Cerebral Hemorrhage - diagnosis; Cerebral Hemorrhage - etiology; Cerebral Infarction - diagnosis; Cerebral Infarction - etiology; Classification; Edema; General aspects; haemorrhage; Hemorrhage; Humans; Ischemia; Magnetic resonance imaging; Medical sciences; Mortality; Neurological disorders; Neurology; Pathophysiology; Patients; Prognosis; Risk Factors; Stroke; Stroke - therapy; thrombolysis; Thrombolytic Therapy - adverse effects; Vascular diseases and vascular malformations of the nervous system; Nervous system diseases; Transformation; Pathogenesis; Acute; Cardiovascular disease; Epidemiology; Fibrinolysis; Hemorrhage; Cerebral disorder; Vascular disease; Medicine; Treatment; Central nervous system disease; Classification; Risk factor; Brain ischemia; Cerebrovascular disease
• ISSN: 0032-5473; 1469-0756
• DOI: 10.1136/pgmj.2007.067058

Haemorrhagic transformation of cerebral infarction is a common and potentially serious occurrence following acute ischaemic stroke. Though often a “natural” evolution, particularly in acute embolic stroke, haemorrhagic transformation is a prime concern with the use of thrombolytic therapy for acute ischaemic stroke. The severity of haemorrhage may range from a few petechiae to a large haematoma with space occupying effect. The pathogenesis of haemorrhagic transformation is not well established, though ischaemia and reperfusion have been proposed to cause disruption of the blood–brain barrier leading to extravasation of blood. At the molecular level, free radicals and proteolotic enzymes (metalloproteinases) may cause tissue injury. Studies have identified a number of clinical, radiological, and biochemical parameters that may serve as potential predictors of increased risk for haemorrhagic transformation. The knowledge of these factors may help in improving patient selection for thrombolytic therapy.