Study on the prognosis of hemorrhagic transformation in extensive ischemic stroke

Abstract

Objective To explore the prognosis of hemorrhagic transformation in extensive ischemic stroke. Methods According to the image changes and clinical findings, 120 patients with extensive (infarct focus > 45 cm3) ischemic stroke were divided into four groups, namely, asymptomatic hemorrhagic transformation group (group A, 20), without cerebral hemorrhage after cerebral ischemia ⁃ reperfusion group (group B, 40), symptomatic cerebral hemorrhagic transformation group (group C, 20), no cerebral ischemia⁃reperfusion and hemorrhage group (group D, 40). The neurologic deficiency degree at different period, Barthel Index (BI) and modified Rankin Scale (mRS) score at 3 months, and head CT imaging at acute stage (low ⁃ density region) and convalescence (encephalomalacia region) were evaluated. The effect of the time of hemorrhagic transformation on prognosis was analysed. Results After 14 d of addmision, the score of neurologic deficiency decreased significantly (24.25 ± 1.18) in group B, but increased (38.74 ± 1.72) and presented clinical exacerbation in group C. There were significant differences among 4 groups (P < 0.05 or P < 0.01, for all). At follow⁃up 1 month, 3 months and 6 months, the score of neurologic deficiency gradually decreased and the neurological function significantly improved in group A and group B, and presented significant differences in comparison with other 2 groups (P < 0.01, for all). After 3 months, Barthel Index and mRS score were significantly improved and neurological function recovered quite well in group A (88.70 ± 6.20, 1.52 ± 0.78, respectively) and group B (89.30 ± 6.10, 1.53 ± 0.76, respectively) and were all superior to other 2 groups (P < 0.01, for all). After treatment, low ⁃ density region or encephalomalacia region on CT were all reduced and no space occupying signs were seen in group A and group B (P < 0.01, for all). The total therapeutic efficiency rate of group A and group B was 100% and 97.50%, respectively, which were all higher than that in the other 2 groups (P < 0.01, for all). Conclusion Hemorrhagic transformation in ischemic stroke does not always present clinical exacerbation. In the early stage, asymptomatic hemorrhagic transformation is a presentation of reperfusion in ischemic stroke. After treatment, the long⁃term neurologic improvement is significant and the prognosis is good in patients with reperfusion, and it is superior to that in patients without reperfusion. In patients with symptomatic hemorrhagic transformation, the clinical symptoms are the additional presentations of ischemic stroke with hemorrhagic transformation, and the prognosis is not satisfactory.

DOI：10.3969/j.issn.1672-6731.2010.02.015