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CT patterns of intracranial hemorrhage complicating thrombolytic therapy for acute myocardial infarction
J P Uglietta1, C M O'Connor, O B Boyko
1Department of Radiology, Duke University Medical Center, Durham, NC.
Insights
Intracranial hemorrhage (ICH) is a rare but serious complication of thrombolytic therapy for acute myocardial infarction. Early symptoms and specific CT findings indicate a grave prognosis, with high mortality rates.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Thrombolytic therapy is a critical treatment for acute myocardial infarction.
- Intracranial hemorrhage (ICH) is a potential complication of such therapies.
- Understanding the patterns and prognosis of ICH is crucial for patient management.
Purpose of the Study:
- To determine the computed tomographic (CT) patterns of intracranial hemorrhage (ICH) in patients receiving thrombolytic therapy for acute myocardial infarction.
- To analyze the clinical presentation, timing, and outcomes associated with ICH in this patient population.
Main Methods:
- Retrospective analysis of 1,696 patients undergoing thrombolytic therapy for acute myocardial infarction.
- Review of CT scans to identify and characterize intracranial hemorrhages.
- Correlation of ICH findings with clinical symptoms and patient outcomes.
Main Results:
- ICH occurred in 0.77% of patients (n=13), with intraparenchymal (36%) and subdural (33%) being the most common types.
- Most hemorrhages were supratentorial (84%), with the most frequent site being supratentorial and intraparenchymal.
- ICH symptoms often appeared within 24 hours of therapy initiation; early symptoms (<3.5 hours) were associated with a higher fatality rate.
- CT findings like multiple bleeding sites, mass effect, midline shift, and large hematomas correlated with increased mortality.
Conclusions:
- Intracranial hemorrhage following thrombolytic therapy for acute myocardial infarction carries a grave prognosis, with a 62% in-hospital mortality rate.
- Specific CT patterns and rapid symptom onset are indicators of poor outcomes.
- This highlights the importance of vigilant monitoring and prompt recognition of ICH in patients receiving thrombolytic therapy.
Abstract:
Computed tomographic (CT) patterns of intracranial hemorrhage (ICH) were determined in 1,696 patients undergoing thrombolytic therapy for acute myocardial infarction. ICH occurred at 33 sites in 0.77% of patients (n = 13). Thirty-six percent of hemorrhages (n = 12) were intraparenchymal, 33% (n = 11) were subdural, 24% (n = 8) were subarachnoid, and 6% (n = 2) were intraventricular. Eight-four percent (n = 26) of all nonventricular hemorrhages were supratentorial in location. The most common site of ICH was supratentorial and intraparenchymal (10 of 33). In 11 of the 13 patients with ICH, clinical symptoms occurred within 24 hours of the initiation of thrombolytic therapy. A fatal outcome resulted in three of the four patients who had clinical symptoms within 3.5 hours after beginning thrombolytic therapy. The CT findings of multiple intracranial bleeding sites, substantial mass effect with midline shift, and large-volume intraparenchymal hematomas were associated with increased mortality. ICH associated with thrombolytic therapy for acute myocardial infarction has a grave prognosis, with 62% of patients dying during hospitalization.