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Web End = Neurol Sci (2017) 38:185187 DOI 10.1007/s10072-016-2728-1
http://crossmark.crossref.org/dialog/?doi=10.1007/s10072-016-2728-1&domain=pdf
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Cerebellar vermis: a vulnerable location of remote brain haemorrhages after thrombolysis for ischaemic stroke
Herbert Tejada-Meza1 Pedro J. Modrego1
Received: 3 August 2016 / Accepted: 3 October 2016 / Published online: 5 October 2016 Springer-Verlag Italia 2016
Abstract Extra-ischaemic (remote) brain heamorrhages after thrombolysis for ischaemic stroke occur in less than 3 % of treated patients, but it worsens prognosis. Little attention has been paid to the location of the haematomas. Among 12 patients with remote brain haemorrhage after thrombolysis, we report three patients with haemorrhage in the cerebellar vermis (25 %), with poor outcome. Previous hypertensive vasculopathy is deemed to be the most plausible cause.
Keywords Thrombolysis Remote brain haemorrhage
Introduction
Intravenous thrombolysis is regarded as the standard of care in ischaemic hyperacute stroke, but there is a nonnegligible risk of brain haemorrhage in around 6 % of treated patients [1]. The haematoma may be located in the ischaemic area but in remote areas of the brain as well, which accounts in 1.3 % of treated patients in the NINDS study [1] and in 2 % of cases in the ECASS2 study [2]. Remote haemorrhages (or extra-ischaemia) make up 727.5 % of brain haemorrhages post-thrombolysis [2, 3]. The reason for remote brain haematomas (RBH) is poorly understood, although some factors have been incriminated such as increased permeability of brain barrier and the action of proteases and free radicals along with the direct effect of r-TPA [2, 3],
The purpose of this study is to share our experience in remote brain haemorrhages post-thrombolysis in terms of location and possible predictors of outcome in comparison with the haemorrhages in the area of infarction.
Patients and methods
Between 2005 and 2015, we treated 560 patients with r-TPA for ischaemic stroke according to international standardised protocol [4]. Informed signed consent was obtained prior to inclusion. Every patient underwent one or more brain CT after thrombolysis to monitor for possible haemorrhage. We compared RBH and non-RBH cases in terms of vascular risk factors, leukoaraiosis, age, sex, NIHSS score at admission, and...