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Updated: Aug 11, 2026
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
[Magnetic resonance imaging of hemorrhagic transformation in ischemic posterior infarction]
M Reimann1, L Niehaus, R Lehmann
1Abteilung für Neuroradiologie, Medizinische Fakultät der Humboldt-Universität zu Berlin.
Purpose:
To describe the incidence, time course, and clinical correlates of hemorrhagic transformation (HT) of ischemic stroke in the posterior cerebral artery territory.
Methods:
Within 42 months 48 patients with 52 occipital lobe infarctions were examined by T1- and T2-weighted MR imaging. The extent and distribution of secondary hemorrhage were analysed at different intervals after stroke. Volume of ischemic and hemorrhagic infarction was measured planimetrically.
Results:
HT was observed in 71% of the infarcts between the 5th day and up to 1 year after stroke. HT was most frequently (88%) observed in the 2nd and 3rd month. HT was present in 55% of small infarcts (< 10 cm3), in 88% of medium size (10-50 cm3), and in all large (> 50 cm3) infarcts. In 92% HT presented with petechial bleedings within the cortex (64%) or less frequently (28%) in subcortical structures. The latter types of HT showed no progression and did not increase the clinical deficits. Space-occupying bleedings occurred in only two large defects.
Conclusions:
In ischemic posterior infarction, HT can frequently be detected within the first three months after stroke and is predominantly of the petechial type and seems not to be relevant with regard to clinical deficits.
Insights
Hemorrhagic transformation (HT) of ischemic stroke in the posterior cerebral artery territory is common, occurring in 71% of cases within the first year. Most HT cases are petechial and do not worsen clinical outcomes.
Area of Science:
- Neurology
- Radiology
- Stroke Medicine
Context:
- Ischemic stroke in the posterior cerebral artery territory can lead to secondary complications.
- Understanding hemorrhagic transformation (HT) is crucial for patient management and prognosis.
Purpose:
- To determine the incidence, timing, and clinical significance of hemorrhagic transformation (HT) in occipital lobe infarcts.
- To analyze the characteristics and progression of HT in ischemic stroke patients.
Summary:
- Hemorrhagic transformation (HT) was observed in 71% of 52 occipital lobe infarcts within one year.
- HT was most frequent in the second and third months post-stroke and correlated with infarct size.
- The majority of HT cases were petechial, primarily in the cortex, and generally did not increase clinical deficits.
Impact:
- This study highlights that HT is a frequent complication of posterior circulation ischemic strokes.
- The findings suggest that petechial HT, common in this territory, may have limited clinical impact.
- Early identification and characterization of HT through advanced imaging are important for stroke care.
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