Haemorrhagic transformation of an ischaemic infarct

Case contributed by Dr Henry Knipe

Presentation

12 hours post stroke.

Patient Data

Age: 80 years
Gender: Male

Extensive gyral thickening and hyperdensity throughout the right frontal and parietal lobes, with focal rounded hyperdensities in the insular cortex and anterior temporal lobe. Suspected subarachnoid haemorrhage at the vertex. Right cerebral hemisphere oedema with partial effacement of the right lateral ventricle and mild leftward midline shift. 

Large region of susceptibility artefact involving most of the right MCA territory, with largely gyriform morphology, reflecting petechial haemorrhagic transformation. 

Case Discussion

This case demonstrates haemorrhagic transformation of an ischaemic stroke can take on two forms:

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

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

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Case information

rID: 48489
Case created: 10th Oct 2016
Last edited: 13th Dec 2016
Tag: stroke
Inclusion in quiz mode: Included

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