[Cerebral hemorrhage complicating early anticoagulant treatment of transient ischemic attacks]

Two patients received intravenous heparin shortly after carotid transient ischemic attacks (TIAs), and developed a cerebral hemorrhage in the same area with 24 hours. CT scan performed before starting anticoagulation was normal, blood pressure was not too high when the hemorrhage developed, although the patients suffered (treated) chronic hypertension, and the Partial Thromboplastin Time did not exceed 90 seconds. No definitive explanation can be provided for this severe complication but recent studies suggest that in some TIAs, significant local ischemic changes may persist after the resolution of clinical symptoms. This risk, although very low, should be considered in cases with chronic arterial hypertension (even treated), because of disturbances of cerebrovascular regulation. In the near future, nuclear magnetic resonance scanning might allow detection of the cases with TIAs, in which focal metabolic alterations persist after disappearance of clinical symptoms.