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Impact of leukoaraiosis on parenchymal hemorrhage in elderly patients treated with thrombolysis

  • Diagnostic Neuroradiology
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Abstract

Introduction

Severity of vascular damage of white matter may predict hemorrhagic transformation (HT). We assess the relationship between leukoaraiosis (LA) severity and the type of hemorrhagic transformation in elderly patients treated with thrombolysis.

Methods

We retrospectively analyzed the clinical data and pretreatment magnetic resonance imaging (MRI) of 180 consecutive ischemic stroke patients aged over 75 years. LA severity was graded according to the Fazekas scale, and acute diffusion-weighted-imaging (DWI) lesion volumes were semi-automatically outlined. Predictors of hemorrhagic infarction (HI) and parenchymal hemorrhage (PH) were identified using logistic regression analysis and exact multinomial logistic analysis.

Results

HT occurred in 31 patients (17 %). Baseline National Institute of Health Stroke Score (NIHSS; p = 0.008), severe LA (p = 0.02), and diffusion lesion volume (p = 0.02) were predictors of HT in univariable logistic regression. Adjusted to lesion volume and baseline NIHSS score, exact multinomial logistic analysis showed that severe LA was the only independent predictor of parenchymal hemorrhage (p = 0.03).

Conclusion

In elderly patients, LA severity better predicts parenchymal hemorrhage than infarct size.

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Abbreviations

LA:

Leukoaraiosis

WMH:

White matter hyperintensity

HT:

Hemorrhagic transformation

ICH:

Intracerebral hemorrhage

HI:

Hemorrhagic infarction

PH:

Parenchymal hemorrhage

NIHSS:

National Institute of Health Stroke Score

MRI:

Magnetic resonance imaging

SVD:

Small-vessel disease

CMBs:

Cerebral microbleeds

tPA:

Tissue plasminogen activator

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Authors and Affiliations

  1. Department of Stroke, Neurological Hospital, Université Lyon 1, Lyon, France

    Norbert Nighoghossian, Tae-Hee Cho, Vincent Cottaz, Laura Mechtouff & Laurent Derex

  2. Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France

    Fatima Abbas & Anne Marie Schott

  3. Department of Neuroradiology, Neurological Hospital, Université Lyon 1, 59 Bd Pinel, 69677, Bron, Lyon, France

    Ana Filipa Geraldo, Elie Janecek, Marc Hermier, Louis Guy Tisserand, Roxana Amelie, Leila Chamard & Yves Berthezene

  4. RESUVAL Stroke Network, Lyon, France

    Magali Bischoff & Carlos El Khoury

Authors
  1. Norbert Nighoghossian
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  2. Fatima Abbas
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  11. Laurent Derex
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  16. Yves Berthezene
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Corresponding author

Correspondence to Yves Berthezene.

Ethics declarations

We declare that all human studies have been approved [data from a regional emergency stroke network health registry in the Rhône Valley, France—RESUVAL Stroke Network—with 5 stroke units (one academic stroke unit and 4 non-academic stroke units), covering a population of 3 million people authorized by the French Ministry of Healthcare, Registration number E-2012-069] and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.

Conflict of interest

We declare that we have no conflict of interest.

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Nighoghossian, N., Abbas, F., Cho, TH. et al. Impact of leukoaraiosis on parenchymal hemorrhage in elderly patients treated with thrombolysis. Neuroradiology 58, 961–967 (2016). https://doi.org/10.1007/s00234-016-1725-7

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  • DOI: https://doi.org/10.1007/s00234-016-1725-7

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