Presentation
12 hours post stroke.
Patient Data
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 hemorrhage at the vertex. Right cerebral hemisphere edema 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 hemorrhagic transformation.
Case Discussion
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.