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Radiology of stroke

¹ Department of Adult Medicine, Tameside General Hospital, Fountain Street, Ashton-under-Lyne OL6 9RW, UK

Keywords: stroke; anticoagulation; haemorrhagic transformation

The optimum time frame for imaging embolic infarcts for stigmata of haemorrhagic transformation should have merited discussion under the heading "special clinical circumstances",¹ not least because of conflicting evidence about the benefits versus risks of early anticoagulation in the context of unpredictable evolution of embolic infarcts with or without anticoagulant treatment. In a study comprising 30 patients with cardiogenic cerebral embolism, three patients with an initially non-haemorrhagic cerebral infarct, visualised by computed tomography within 12 hours of stroke onset, showed asymptomatic haemorrhagic transformation in the absence of anticoagulant treatment 2–8 days later. One other patient in this subgroup did, however, develop sudden worsening of hemiparesis despite having initially presented with a small infarct.² Among 1457 patients anticoagulated with unfractionated heparin in the presence of embolic cerebral infarct associated with atrial fibrillation, haemorrhagic transformation (within 14 days) was significantly commoner (p < 0.0001) than in their non-heparinised counterparts.³ Ischaemic stroke recurred . . . [Full text of this article]

J M Wardlaw²

² Department of Clinical Nurosciences, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK