PT  - JOURNAL ARTICLE
AU  - de Freitas, G R
AU  - Carruzzo, A
AU  - Tsiskaridze, A
AU  - Lobrinus, J A
AU  - Bogousslavsky, J
TI  - Massive haemorrhagic transformation in cardioembolic stroke: the role of arterial wall trauma and dissection
AID  - 10.1136/jnnp.70.5.672
DP  - 2001 May 01
TA  - Journal of Neurology, Neurosurgery & Psychiatry
PG  - 672--674
VI  - 70
IP  - 5
4099  - http://jnnp.bmj.com/content/70/5/672.short
4100  - http://jnnp.bmj.com/content/70/5/672.full
SO  - J Neurol Neurosurg Psychiatry2001 May 01; 70
AB  - The pathogenesis of massive haemorrhagic transformation is not well established. Fatal haemorrhagic transformation associated with in situ dissection after acute middle cerebral artery (MCA) occlusion in a patient with atrial fibrillation is reported. An 80 year old woman with atrial fibrillation developed mild hemiparesis and aphasia. Brain CT and MRI at 4 and 5 hours, respectively, of symptom onset showed proximal MCA trunk occlusion with developing striatocapsular infarct and hypoperfusion in the superficial MCA territory. A few hours later, she developed massive bleeding into the ischaemic area and died. Pathological examination showed MCA trunk dissection, surrounded by a subarachnoid clot which communicated with the cerebral haematoma. It is suggested that direct arterial wall trauma as a result of cardioembolic MCA occlusion caused bleeding into the infarct. Secondary in situ dissection may be an overlooked mechanism of haemorrhagic transformation.