Predictors of Hemorrhage Volume after Intravenous Thrombolysis

BACKGROUND

Symptomatic intracerebral hemorrhage (sICH) is one of the most feared complications after administration of intravenous recombinant tissue plasminogen activator (IV rtPA). The aim of this study was to determine correlations between hemorrhage volume (HV) after IV rtPA treatment and risk factors for sICH.

METHODS

We analyzed 318 patients from the stroke registries of 4 hospitals in Korea. We confirmed hemorrhage by computed tomography (CT) or magnetic resonance imaging within 36 hours. Patient groups were classified by HV (0, 0-10, 10-25, and greater than 25 mL). Based on the HV, we evaluated the following: (1) predictors for hemorrhage; (2) rates of sICH according to various sICH definitions; and (3) 3-month functional outcomes after IV rtPA treatment.

RESULTS

Among the 318 patients, hemorrhage occurred in 72 patients. HV was significantly correlated with atrial fibrillation (OR = 3.38, 95% CI = 1.87-6.09), early CT changes (OR = 3.17, 95% CI = 1.69-5.93), and dense artery sign (OR = 1.90, 95% CI = 1.07-3.39). Compared with the groups with HV less than 25 mL, patients with an HV of greater than 25 mL were more likely to have higher mortality rates (33.3% versus 11.8%) and worse outcomes at 3 months (good: 8.3% versus 50.3%; excellent: 0% versus 33.7%).

CONCLUSIONS

HV after IV rtPA is an important predictor of clinical outcomes. Atrial fibrillation, early CT changes, and dense artery sign were significantly associated with large HVs; therefore, these patient factors might be considered before and after thrombolytic treatment.

Glycemic and vascular choreoballism as main causes of secondary choreoballism involving the putamen

BACKGROUND

The putamen is frequently involved in cases of secondary choreoballism (CB). To date, no study has investigated clinical features of secondary CB such as vascular CB (vCB) and glycemic CB (gCB) in view of putaminal involvement.

OBJECTIVES

Cases of CB with putaminal lesions from our hospital were identified in hospital records. Historical cases were obtained from the MEDLINE database. Cases of gCB are defined as those with CB, diabetes mellitus and high signal intensities (HSIs) in the putamen on T1 weighted imaging (T1WI). Cases of vCB are identified among those with CB and stroke involving the putamen.

RESULTS

A total of 284 cases (in-hospital cases, 11 gCB and 3 vCB; historical cases, 225 gCB and 45 vCB) were included after excluding 23 glycemic cases without HSIs on T1WI and 53 cases with non-glycemic etiologies. Persistence of CB was longer than one month in 84 cases (gCB, 36.9%, and vCB, 63.0%). Extra-putaminal lesions occurred more frequently in vCB (71.1%) than gCB (50.7%). Age, cerebrovascular etiology and extra-putaminal lesions were found to be significant predictors for persistence of CB one month after onset. Female gender and extra-putaminal lesions were significant predictors for persistence of CB one year after onset.

CONCLUSIONS

gCB was the primary common cause of secondary CB involving the putamen. Older age, female gender, vascular etiologies and extensive lesions (putaminal and extra-putaminal) were significant predictors of CB persistence.