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Reliable predictors of symptomatic intracerebral hemorrhage (sICH) following reperfusion therapy in acute ischemic stroke can inform decision-making in the acute setting. Several clinical variables, including stroke severity, elevated blood pressure, and hyperglycemia, have been consistently associated with an increased risk of sICH following treatment with IV recombinant tissue plasminogen activator (rtPA).1 Early clear hypodensity or mass effect on non–contrast-enhanced head CT also predicts symptomatic hemorrhage.2 Some stroke centers have adopted the use of brain MRI in lieu of CT, given its sensitivity to detect acute hemorrhage and ability to estimate degree of infarction and brain “at risk” before thrombolysis or mechanical clot retrieval. Previous studies of asymptomatic cerebral microbleeds detected with gradient-recalled echo or susceptibility-weighted sequences on brain MRI have reached inconsistent conclusions regarding the risk of sICH following thrombolysis.3,4
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See page 927
- © 2015 American Academy of Neurology
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