Skip to main content

Fatal or severely disabling cerebral infarction during hospitalization for stroke or transient ischemic attack

Journal of Neurology volume 237, pages 306–309 (1990)Cite this article

Summary

Six (1%) of 578 patients admitted for cerebral infarction or transient ischemic attack (TIA) suffered a fatal or severely disabling in-hospital cerebral infarction following a period of stabilization or improvement lasting more than 1 day. These infarctions were characterized by the sudden onset of stupor or coma and subsequent development of transtentorial herniation due to carotid or middle cerebral artery territory infarction, or widespread brain-stem infarction due to basilar occlusion. Only one patient survived. Four patients had largevessel disease documented by Doppler, angiography, or at autopsy. Each of these six infarcts occurred during the morning hours, 4–9 days after the initial event, 3–8 days after initiation of intravenous heparin, and within 4–8 h after intravenous heparin had been discontinued. No coagulation abnormalities were documented. We believe that these cases indicate that among patients admitted for cerebral infarction or TIA, fatal or severely disabling in-hospital cerebral infarction after a period of stabilization or improvement may occur in patients having an initially mild to moderate clinical deficit, that those suffering large artery disease may be at greater risk, and that there may be a relationship between heparin withdrawal and cerebral infarction in some patients.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Alter M, Sobel E, McCoy RL, Francis ME, Davanipour A, Sofer F, Levitt LP, Meehan EF (1987) Stroke in the Lehigh Valley: risk factors for recurrent stroke. Neurology 37:503–507

    Google Scholar 

  2. Broekmans AW, Veltkamp JJ, Bertina RM (1983) Congenital protein C deficiency and venous thromboembolism: a study of three Dutch families. N Engl J Med 309:340–344

    Google Scholar 

  3. Chong BH, Pitney WR, Castaldi PA (1982) Heparin-induced thrombocytopenia: association of thrombotic complications with heparin-dependent IgG antibody that induces thromboxane synthesis and platelet aggregation. Lancet II:1246–1249

    Google Scholar 

  4. D'Angelo A, Landi L, Vigano'D'Angelo S, Orazio EN, Boccardi E, Candelise L, Mannucci PM (1988) Protein C in acute stroke. Stroke 19:579–583

    Google Scholar 

  5. Donnan GA (1986) In hospital stroke and TIA recurrence rates. In: Donnan GA, Vajda F (eds) Perspective in stroke. York Press, Victoria, pp 119–125

    Google Scholar 

  6. Epstein DJ, Bergum PW, Rapaport SI (1983) Kinetics of protein C depression after Coumadin administration. Circulation 68 (Suppl III):1264

    Google Scholar 

  7. Kubota K, Sakurai T, Tamura J, Sirakura T (1987) Is the circadian change in hematocrit and blood viscosity a factor triggering cerebral and myocardial infarction? Stroke 18:812–813

    Google Scholar 

  8. Marciniak E, Gockerman JP (1977) Heparin induced decrease in circulating antithrombin III. Lancet II:581–584

    Google Scholar 

  9. Marshall J (1977) Diurnal variation in occurrence of strokes. Stroke 8:230–231

    Google Scholar 

  10. Millar-Craig MW, Bishop CN, Raftery EB (1987) Circadian variation of blood pressure. Lancet I:795–797

    Google Scholar 

  11. Muller JE, Stone PH, Turi AZ, Rutherford JD, Czeisler CA, Parker C, Poole WK, Passamani E, Roberts R, Robertson T, Sobel BE, Willerson JT, Braunwald E (1985) Circadian variation in the frequency of onset of acute myocardial infarction. N Engl J Med 313:1315–1322

    Google Scholar 

  12. Ramierz-Lassepas M, Cipolle RJ, Rodvold KA, Seifert RD, Strand L, Taddeini L, Cusulos M (1984) Heparin-induced thrombocytopenia in patients with cerebrovascular disease. Neurology 34:736–740

    Google Scholar 

  13. Ramirez-Lassepas M, Quinones MR, Nino HH (1986) Treatment of acute ischemic stroke — open trial with continuous intravenous heparinization. Arch Neurol 43:386–390

    Google Scholar 

  14. Rao AK, Niewiarowski S, Guzzo J, Day HJ (1981) Antithrombin III levels during heparin therapy. Thromb Res 24:181–186

    Google Scholar 

  15. Sacco RL, Foulkes MA, Mohr JP, Wolf PA, Hier DB, Price TR (1988) Determinants in early recurrence of cerebral infarction: Stroke Data Bank. Stroke 19:144

    Google Scholar 

  16. Slivka AP, Levy DE (1987) Risk associated with heparin withdrawal in ischemic cerebrovascular disease. Stroke 18:298

    Google Scholar 

  17. Tofler GH, Brezinski D, Schafer AI, Czeisler CA, Rutherford JD, Willich SN, Gleason RE, Williams GH, Muller JE (1987) Concurrent morning increase in platelet aggregability and the risk of myocardial infarction and sudden cardiac death. N Engl J Med 316:1514–1518

    Google Scholar 

  18. Turton MB, Deegan T (1974) Circadian variations of plasma catecholamine, cortisol and immunoreactive insulin concentrations in supine subjects. Clin Chim Acta 55:389–397

    Google Scholar 

Download references

Author information

Affiliations

  1. Stroke Service, Department of Neurology, The Neurological Institute of New York, New York, USA

    G. W. Petty, T. K. Tatemichi, R. L. Sacco & J. P. Mohr

  2. Department of Medicine, The Presbyterian Hospital in the City of New York, The College of Physicians and Surgeons of Columbia University, New York, USA

    J. Owen

Authors
  1. G. W. Petty
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. K. Tatemichi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. L. Sacco
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Owen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. P. Mohr
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Supported in part by the Sunny von Bulow Coma and Head Trauma Research Foundation

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Petty, G.W., Tatemichi, T.K., Sacco, R.L. et al. Fatal or severely disabling cerebral infarction during hospitalization for stroke or transient ischemic attack. J Neurol 237, 306–309 (1990). https://doi.org/10.1007/BF00314748

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00314748

Key words

  • Cerebrovascular disease
  • Cerebral infarction
  • Coma
  • Heparin