Hemorrhagic transformation of an ischemic 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 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. 

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Case information

rID: 48489
Published: 11th Oct 2016
Last edited: 16th Jul 2018
Tag: stroke
Inclusion in quiz mode: Included

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