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Remote cerebral hematomas in patients treated with intravenous rt-PA

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Abstract

The frequency, clinical presentation, radiological features, and prognosis of remote cerebral hematomas (rPH) are not well known. We report our experience in patients treated with intravenous rt-PA. We reviewed our database of consecutive patients treated at our hospital from 1999 to 2008. We used the inclusion/exclusion criteria of the ECASS-2 study from 1999 to 2003, and the criteria of the SITS-MOST study since 2004. A follow-up CT scan was obtained in all of the patients within the first 36 h of treatment. Cerebral hemorrhagic complications were classified as hemorrhagic infarction (HI-1/HI-2) and parenchymal hematoma (PH-1/PH-2). The rPH was defined as any extra-ischemic hemorrhagic lesion observed in the follow-up CT. A favorable outcome was defined as a score 0–1 on the Rankin scale at 3 months. We treated 210 patients (mean age 67.6 ± 12.4 years, 56% were men). The median initial NIHSS score was 14. Patients with rPH (n = 7) had a mean age of 72.4 ± 7.5 years and 43% were men. The median initial NIHSS score was 15. Three patients had multifocal rPH; three patients had a single rPH and in one patient the rPH was associated with a PH-2. rPH were lobar in six patients and in brainstem in one patient, symptomatic in five patients and asymptomatic in two patients. The outcome was unfavorable in all of them; four deaths (57%) were recorded. Remote cerebral hemorrhage is an infrequent complication after rt-PA treatment (3.3%), it is usually lobar and symptomatic and has an uniformly unfavorable outcome.

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Authors and Affiliations

  1. Department of Neurology, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain

    Eugenia Martínez-Hernández, Sergi Martínez-Ramírez, Raquel Delgado-Mederos, Daniel Alcolea, Marta Marquié, Rebeca Marín, Josep Lluis Martí-Vilalta & Joan Martí-Fàbregas

  2. Department of Neuroradiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

    Manuel De Juan

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  1. Eugenia Martínez-Hernández
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  2. Sergi Martínez-Ramírez
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  3. Raquel Delgado-Mederos
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  4. Daniel Alcolea
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  5. Marta Marquié
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  8. Josep Lluis Martí-Vilalta
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  9. Joan Martí-Fàbregas
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Correspondence to Eugenia Martínez-Hernández.

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Martínez-Hernández, E., Martínez-Ramírez, S., Delgado-Mederos, R. et al. Remote cerebral hematomas in patients treated with intravenous rt-PA. J Neurol 257, 1062–1066 (2010). https://doi.org/10.1007/s00415-010-5462-2

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  • DOI: https://doi.org/10.1007/s00415-010-5462-2

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