This case demonstrates hemorrhagic transformation of an ischemic stroke can take on two forms:

• petechial hemorrhage (expected evolution of a stroke)
• parenchymal hematoma (often a complicating factor, especially in the context of thrombolysis)

Clinicians are most concerned with parenchymal hematoma, these can be large and have significant mass effect, sometimes requiring craniectomy and evacuation of hematoma.