Hemorrhage after an acute ischemic stroke

Background and Purpose-Hemorrhagic transformation is frequently seen on CT scans obtained in the subacute phase of ischemic stroke. Its prognostic val ue is controversial. Methods-We analyzed 554 patients with acute ischemic stroke enrolled in the Multicenter Acute Stroke Trial-Italy (MAST-I) study in whom a second CT sc an was performed on day 5. Presence of 1) intraparenchymal hemorrhages (hem atoma or hemorrhagic infarction), 2) extraparenchymal bleeding (intraventri cular or subarachnoid) and 3) cerebral edema (shift of midline structure, s ulcal effacement or ventricular compression) alone or in association were e valuated. Death or disability at 6 months were considered as "unfavorable o utcome." Results-Patients who developed intraparenchymal hemorrhages, extraparenchym al bleeding, or cerebral edema had unfavorable outcome (83%, 100%, and 80%, respectively), but multivariate analysis demonstrated that only extraparen chymal bleeding (collinearity) and cerebral edema (OR=6.8; 95% CI, 4.5 to 1 0.4) were significant independent prognostic findings. Unfavorable outcome correlated with size of intraparenchymal hemorrhage (chi(2) for trend=30.5, P<0.0001), Nevertheless, when a large hematoma was present the negative ef fect was mostly due to concomitant extraparenchymal bleeding (chi(2)=51.6, P<0.0001), and when hemorrhagic infarction was detected the negative effect was mostly explained by the association with cerebral edema (chi(2)=36.6, P<0.0001). Conclusions-Extraparenchymal bleeding and cerebral edema are the main progn ostic CT scan findings in the subacute phase of ischemic stroke. Stroke pat ients with a high risk for developing these 2 types of brain damage should be identified. Measures to prevent and adequately treat their development s hould be implemented.