RT Journal Article
SR Electronic
T1 Massive haemorrhagic transformation in cardioembolic stroke: the role of arterial wall trauma and dissection
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP 672
OP 674
DO 10.1136/jnnp.70.5.672
VO 70
IS 5
A1 G R de Freitas
A1 A Carruzzo
A1 A Tsiskaridze
A1 J A Lobrinus
A1 J Bogousslavsky
YR 2001
UL http://jnnp.bmj.com/content/70/5/672.abstract
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.