A Clinical Study of Hemorrhagic Infarction

J Korean Neurol Assoc > Volume 13(3); 1995 > Article

Journal of the Korean Neurological Association 1995;13(3): 479-489.

출혈성 뇌경색에 대한 임상연구

최 영철, 정진상, 남선우, 이애영, 김재문

충남대학교 신경과, 삼성의료원 신경과

A Clinical Study of Hemorrhagic Infarction

Young Cheol Choi, M.D., Chin Sang Chung, M.D., Ph.D., Seon Woo Nam, M.D., Ae Young Lee, M.D., Jae Moon Kim, M.D., Ph.D.

Department of Neurology, Chugnam National University Medical College and Hospital, Taejon and Samsung Medecal Center

Abstract

Hemorrhagic conversion (HC) of a cerebral infarct is a radiological sign of reperfusion to the infarcted tissue. Recently the concept on HC needs to be revised in relation to advanced therapeutic trials for acute ischeniic strokes. To investigate the clinical significance of HC of a bland cerebral infarct, we analyzed the clinical and neuroimaging files of 70 stroke patients showing HC on the brain CT and/or MRI scans. We also studied the best-possible stroke mechanisms on clinicolaboratory grounds, the factors that might have contributed to HC, and the prognostic impact of HC. Of 70 patients with HC, 51 had infarcts in the carotid artery system, 18 in the vertebrobasilar system, and 1 in cerebral venous system. Definite cardioembolic sources were identified in 21 patients (30%). HC was associated with antithrombotic therapy in 21 patients (30%). Other stroke mechanisms included migraine (23 cases), moyamoya disease (2, cases), thrombotic thrombocytopenic purpura (I case), postoperative vasospasm (1 case), and dural sinus thrombosis (I case). We identified a subset of 14 patients with HC of isolated subcortical infarcts but without definite embolic sources. Sixty-four of 70 patients (91.5%) remained clinically stable or improved after HC, suggesting a relative safety of HC in this retrospective study. In conclusion HC follows cerebral infarctions caused by various non-embolic mechanisms as well as by embolism. HC was not a bad prognostic sign in tl-iis small series.