Hemorrhagic risk of recent silent cerebral infarct on prethrombolysis MR imaging in acute stroke

Abstract

Background and purpose: EIH is a rare complication after thrombolysis in patients with acute stroke, occurring in brain regions without visible ischemic change on pretreatment imaging. RSCIs can be detected by multimodal MR imaging and might be associated with an increased risk of HT postthrombolysis, related to BBBD. We aimed to assess the incidence of RSCI on pretreatment MR imaging and the subsequent risk of HT within RSCI areas on follow-up CT performed <36 hours after rtPA administration and on additional cerebral imaging before patient discharge.

Materials and methods: Pretreatment MR imaging was retrospectively analyzed from consecutive patients with stroke who received intravenous or intra-arterial rtPA for 2 years. RSCI was defined on MR imaging as a parenchymal area markedly hyperintense on FLAIR, different from the hyperacute infarct, and mildly-to-markedly hyperintense on DWI or enhanced on postgadolinium T1WI imaging.

Results: Eighty-six patients with a median age of 66 years and a median NIHSS score on admission of 15 were studied; 66.3% received rtPA intravenously. The presence of RSCI was identified in 10 patients (11.6%) and was associated with large-vessel-disease etiology (40% versus 5.3%, P < .001) on univariate analysis. No HT was identified within the RSCI areas on any follow-up cerebral imaging.

Conclusions: These preliminary results require validation but suggest that small RSCIs are rather frequent and might not pose a higher risk of postthrombolysis HT.

Fig 1.

Three different patterns of RSCIs defined on MR imaging. A, “Gad+/DWI+” indicates area enhanced on postgadolinium T1WI imaging and in hypersignal intensity on DWI. B, “Gad+/DWI−” is the area enhanced on postgadolinium T1WI imaging but not in hypersignal on DWI. C, “Gad−/DWI+” is the area unenhanced on postgadolinium T1WI but in hypersignal intensity on DWI. GAD indicates gadolinium.