CT after intracranial intraarterial thrombolysis for acute stroke

S. L. Wildenhain, C. A. Jungreis, J. Barr, J. Mathis, L. Wechsler, J. A. Horton

Research output: Contribution to journalArticle

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Abstract

PURPOSE: To determine the incidence, appearance, and clinical significance of lesions mimicking intraparenchymal hemorrhages on CT in patients treated with intracranial intraarterial thrombolysis for acute strokes. METHODS: Ten cases of acute stroke treated with direct intraarterial urokinase infusion were retrospectively reviewed. Clinical and radiographic findings before and after therapy were all evaluated. RESULTS: Six (60%) of the 10 patients showed areas of increased attenuation on CT shortly after thrombolytic therapy. The lesions were associated with clinical deterioration in two cases (20%); in these two cases the lesions persisted on CT for several days. The lesions were asymptomatic in two (20%) cases; the lesions cleared on CT within 24 hours in those two patients. In two (20%) patients, immediate clinical improvement was evident despite the radiodense areas. These lesions also cleared within 24 hours. CT Hounsfield unit measurements of four of the lesions revealed very high Hounsfield units in two lesions, only one of which was a symptomatic lesion. MR in two cases revealed residua of hemorrhage. CONCLUSION: Intraparenchymal areas of increased attenuation may be seen on the CT scans of patients after intraarterial thrombolysis. The density is often at least partially attributable to contrast extravasation. The lesions should not necessarily be interpreted as hemorrhage alone, especially in the absence of clinical deterioration. Rapid clearing may be a positive prognostic sign.

Original languageEnglish (US)
Pages (from-to)487-492
Number of pages6
JournalAmerican Journal of Neuroradiology
Volume15
Issue number3
StatePublished - 1994

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Stroke
Hemorrhage
Intra Arterial Infusions
Thrombolytic Therapy
Urokinase-Type Plasminogen Activator
Incidence
Therapeutics

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Wildenhain, S. L., Jungreis, C. A., Barr, J., Mathis, J., Wechsler, L., & Horton, J. A. (1994). CT after intracranial intraarterial thrombolysis for acute stroke. American Journal of Neuroradiology, 15(3), 487-492.

CT after intracranial intraarterial thrombolysis for acute stroke. / Wildenhain, S. L.; Jungreis, C. A.; Barr, J.; Mathis, J.; Wechsler, L.; Horton, J. A.

In: American Journal of Neuroradiology, Vol. 15, No. 3, 1994, p. 487-492.

Research output: Contribution to journalArticle

Wildenhain, SL, Jungreis, CA, Barr, J, Mathis, J, Wechsler, L & Horton, JA 1994, 'CT after intracranial intraarterial thrombolysis for acute stroke', American Journal of Neuroradiology, vol. 15, no. 3, pp. 487-492.
Wildenhain SL, Jungreis CA, Barr J, Mathis J, Wechsler L, Horton JA. CT after intracranial intraarterial thrombolysis for acute stroke. American Journal of Neuroradiology. 1994;15(3):487-492.
Wildenhain, S. L. ; Jungreis, C. A. ; Barr, J. ; Mathis, J. ; Wechsler, L. ; Horton, J. A. / CT after intracranial intraarterial thrombolysis for acute stroke. In: American Journal of Neuroradiology. 1994 ; Vol. 15, No. 3. pp. 487-492.
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AU - Horton, J. A.

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AB - PURPOSE: To determine the incidence, appearance, and clinical significance of lesions mimicking intraparenchymal hemorrhages on CT in patients treated with intracranial intraarterial thrombolysis for acute strokes. METHODS: Ten cases of acute stroke treated with direct intraarterial urokinase infusion were retrospectively reviewed. Clinical and radiographic findings before and after therapy were all evaluated. RESULTS: Six (60%) of the 10 patients showed areas of increased attenuation on CT shortly after thrombolytic therapy. The lesions were associated with clinical deterioration in two cases (20%); in these two cases the lesions persisted on CT for several days. The lesions were asymptomatic in two (20%) cases; the lesions cleared on CT within 24 hours in those two patients. In two (20%) patients, immediate clinical improvement was evident despite the radiodense areas. These lesions also cleared within 24 hours. CT Hounsfield unit measurements of four of the lesions revealed very high Hounsfield units in two lesions, only one of which was a symptomatic lesion. MR in two cases revealed residua of hemorrhage. CONCLUSION: Intraparenchymal areas of increased attenuation may be seen on the CT scans of patients after intraarterial thrombolysis. The density is often at least partially attributable to contrast extravasation. The lesions should not necessarily be interpreted as hemorrhage alone, especially in the absence of clinical deterioration. Rapid clearing may be a positive prognostic sign.

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