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[Thrombolytic therapy in myocardial infarction. Computerized tomography of encephalic complications]
G Brancatelli1, G Sparacia, A Banco
1Istituto di Radiologia P. Cignolini dell'Università, Palermo, Italy.
Insights
Intracerebral hemorrhage after thrombolytic therapy for myocardial infarction is rare but serious. Large hemorrhages with mass effect on CT scans indicate poor outcomes.
Area of Science:
- Neurology
- Radiology
- Cardiology
Background:
- Thrombolytic therapy is crucial for acute myocardial infarction.
- Intracerebral hemorrhage is a known complication of thrombolytic therapy.
- Understanding CT findings is vital for patient management.
Purpose of the Study:
- To evaluate CT findings of intracerebral hemorrhage in patients receiving thrombolytic therapy for acute myocardial infarction.
- To correlate intracerebral hemorrhage characteristics with clinical outcomes.
Main Methods:
- Retrospective review of clinical records and CT scans of 302 patients.
- Analysis of hemorrhage number, sites, size, and mass effect.
- Classification of hemorrhage sites: intraparenchymal, intraventricular, subdural, subarachnoid.
Main Results:
- Six patients (2%) developed intracerebral hemorrhage within 24 hours of therapy.
- Most common sites were supratentorial and intraparenchymal.
- Large hematomas with mass effect and midline shift correlated with mortality.
Conclusions:
- Supratentorial and intraparenchymal hemorrhages were most common.
- Large volume, multiple hemorrhages, and mass effect increased mortality.
- Fluid-blood level hematomas were frequently observed.
Purpose:
To evaluate the CT findings of intracerebral hemorrhage in patients undergoing thrombolytic therapy for acute myocardial infarction and to correlate the type of intracerebral hemorrhage with clinical outcome.
Material And Methods:
We retrospectively reviewed the clinical records and CT scans of intracerebral hemorrhage on a total of 302 patients who underwent thrombolytic therapy for acute myocardial infarction at our institution from January 1996 to September 1999. In each patient we evaluated: the number, sites and size of hemorrhage, and the presence and severity of mass effect. The site of the hemorrhage was classified as intraparenchymal, intraventricular, subdural and subarachnoid.
Results:
Six patients (2%, mean age 74, range 66-80) developed intracerebral hemorrhage. There was a total of 22 hemorrhages: 1 subdural hemorrhage, 6 subarachnoid, 11 intraparenchymal and 4 intraventricular. Excluding intraventricular hemorrhage, 14/18 hemorr-hages were located supratentorially. In five patients there was a fluid-blood level. Three patients had severe mass effect with midline shift. Symptoms presented within 24 hours from the administration of thrombolytic therapy in all patients. All the patients who died had a large hematoma with a severe mass effect and a severe midline shift at CT scan. In the remaining patients, the hematoma was of medium size and no mass effect was seen.
Conclusions:
The most common site of hemorrhage was supratentorial and intraparenchymal. Large volume intracerebral hemorrhage, multiple hemorrhages and mass effect with midline shift were associated with increased mortality. The most commonly observed finding was a fluid-blood level hematoma.