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Hemorrhagic infarction on CT in cardioembolic stroke
Insights
Early anticoagulant treatment in cardioembolic stroke patients requires careful CT scan evaluation. Initial CT scans can identify infarction and hemorrhagic transformation, aiding treatment decisions and minimizing risks.
Area of Science:
- Neurology
- Radiology
- Cardiology
Background:
- Cardioembolic stroke necessitates prompt management, often involving anticoagulation.
- Computed tomography (CT) is crucial for diagnosing stroke and guiding treatment.
- The risk of hemorrhagic transformation during anticoagulation requires careful assessment.
Purpose of the Study:
- To evaluate the utility of CT scans in patients with cardioembolic stroke undergoing anticoagulation.
- To determine the incidence of hemorrhagic infarction in patients treated with anticoagulants.
- To assess the role of CT in risk stratification for early anticoagulant therapy.
Main Methods:
- Retrospective analysis of CT scans from 103 patients with cardioembolic stroke.
- Data collected from a prospective registry focusing on early anticoagulant treatment risks.
- CT scans reviewed for infarction and hemorrhagic transformation, including initial and follow-up imaging.
Main Results:
- 66 out of 103 CT scans (64%) showed infarction.
- Initial CT revealed hemorrhagic infarcts in 5% of patients.
- Follow-up CT in 35 patients showed hemorrhagic infarction in 17%, without clinical worsening.
Conclusions:
- Hemorrhagic infarction on CT does not definitively indicate a cardioembolic stroke origin.
- CT imaging is valuable in assessing risks associated with early anticoagulant treatment in cardioembolic stroke.
- Careful interpretation of CT findings is essential for safe and effective anticoagulation management.
Abstract:
CT-scans of 103 patients anticoagulated following cardioembolic stroke were evaluated. Data were taken from a prospective registry on the risk of early anticoagulant treatment in patients with cardioembolic stroke. Ninety-three patients had CT within 24 hours after stroke onset. Sixty-six of 103 CT-scans showed infarction. On initial CT five hemorrhagic infarcts were found (5%). Of 35 follow-up CT-scans randomly performed during anticoagulant treatment, six (= 17%) showed hemorrhagic infarction without clinical worsening. It is argued that a cardioembolic cause of stroke cannot be infered by the presence of HI on CT. In patients with a cardioembolic stroke the value of CT lies in minimizing the risk of early anticoagulant treatment.