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Hemorrhagic transformation of stroke secondary to spontaneous internal carotid artery dissection

Ju-Sing Fan1, Feng-Chi Chang, Han-Hwa Hu

  • 1Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.

Journal of the Chinese Medical Association : JCMA
|December 22, 2006
PubMed

Insights

Hemorrhagic transformation can occur early in patients with spontaneous cervical internal carotid artery dissection (ICAD) and ischemic stroke, even before treatment. Caution is advised when using antithrombotic agents in these cases.

Area of Science:

  • Neurology
  • Vascular Neurology
  • Neuroimaging

Background:

  • Spontaneous cervical internal carotid artery dissection (ICAD) is a significant cause of ischemic stroke in young adults.
  • The clinical trajectory, particularly the risk of hemorrhagic transformation (HT), following ICAD remains incompletely understood.

Observation:

  • A 36-year-old male presented with headache and left hemiparesis.
  • MRI revealed right ICAD with near-complete occlusion and an ischemic stroke in the right basal ganglia.
  • The stroke exhibited early hemorrhagic transformation in its central region.

Findings:

  • Hemorrhagic transformation can manifest early in the course of spontaneous ICAD-related ischemic stroke.
  • This early HT can occur even in the absence of prior antithrombotic therapy.

Implications:

  • Clinicians should exercise caution when initiating antithrombotic agents in patients with spontaneous ICAD and ischemic stroke due to the potential for early hemorrhagic transformation.
  • Further research into the pathomechanisms and optimal treatment strategies for ICAD with early HT is warranted.

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