REVIEWS

Intracerebral haemorrhage after thrombolysis for acute ischaemic stroke: an update

L Derex, N Nighoghossian

Service d’Urgences Neurovasculaires, Hôpital Neurologique, Lyon, France and CREATIS, UMR CNRS 5515, Claude Bernard University, INSERM, Lyon, France

Dr L Derex, Service d’Urgences Neurovasculaires, Hôpital Neurologique, 59 boulevard Pinel, 69003 Lyon, France; laurent.derex{at}chu-lyon.fr

Intracerebral haemorrhage (ICH) still represents the most feared complication of thrombolysis. Our aim was to review the literature regarding clinical, biological and imaging predictors of ICH following thrombolysis for acute ischaemic stroke. Relevant studies were identified through a search in Pubmed, using the following key words: "intracerebral", "haemorrhage", "stroke" and "thrombolytic". The query was limited to studies published in the English literature. The reference lists of all relevant articles were reviewed to identify additional studies. The main predictors of clinically significant ICH were age, clinical stroke severity, as assessed by the National Institute of Health Stroke Scale score on admission, high blood pressure, hyperglycaemia, early CT changes, large baseline diffusion lesion volume and leukoaraiosis on MRI. The contribution of biomarkers in the prediction of the ICH risk is currently under evaluation. Available data on patients with limited number of microbleeds on pretreatment gradient echo MRI sequences suggest safe use of thrombolysis. ICH after stroke thrombolysis is a complex and heterogeneous phenomenon, which involves numerous parameters whose knowledge remains partial. To minimise the risk of tissue plasminogen activator (tPA) related symptomatic ICH, careful attention must be given to the pre-therapeutic glycaemia value, and a strict protocol for the control of elevated blood pressure is needed during the first 24 h. Future research should focus on predictors of severe intracerebral haemorrhagic complications (parenchymal haematomas type 2 according to the European Cooperative Acute Stroke Study (ECASS) classification). The input of multimodal MRI and biological predictors of ICH deserves further investigation.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Mazumder, A. A., Pope, G. A. (2009). Stroke quiz. BMJ 339: b3343-b3343 [Full Text]  
• Alawneh, J. A., Moustafa, R. R., Baron, J.-C. (2009). Hemodynamic Factors and Perfusion Abnormalities in Early Neurological Deterioration. Stroke 40: e443-e450 [Abstract] [Full Text]