Analysis Of Clinical Characteristics And Related Risk Factors Of Hemorrhagic Transformation After Cerebral Infarction

Hemorrhagic transformation(HT) is secondary hemorrhage within the infarction ofischemic stroke, which is a common complication of acute cerebral infarction. The incidenceof HT in the domestic and foreign reports vary from3%to80%,including the ratio ofsymptomatic intracranial hemorrhage(SICH) from1.5%to5%.Since the development ofimaging techniques and the application of thrombolytic therapy, the detection rate and theincidence of HT was significantly higher than before.HT is divided into hemorrhagic infarction(HI) and parenchymal hemorrhage(PH)according to the brain CT.Some patients with hemorrhagic transformation,especially thosewith PH,have a high morbidity and mortality.Some research on the prognosis of HT come toa conclusion that PH-2exacerbate the condition inducing worse prognosis anddisability,even death,while those of PH-1,HI-2and HI-1without bad effect on the prognosis.The application of head computed tomography scan(CT) and magnetic resonanceimanging(MRI) brings a lot of convenience,but the examination are not regular reviewproject after cerebral infarction,even after treatment.Therefore,some HT patients withoutdeterioration are still easy to be ignored.So determination of the clinical features,the time ofonset and risk factors of HT would be favorable for clinical screening of such cases and dothe imaging eaxamination with more exact purpose to further improve the diagnosis andtreatment.These results are not only conductive to the early diagnosis of HT,but alsobeneficial to the prevention.Meanwhile it provides a clinical basis for reducing the risk ofhemorrhagic transformation after cerebral infarction and thrombolysis,and brings apossibility to expand the scope of thrombolytic therapy.The study reviewed retrospectively49hospitalized patients with HT in the firstNeurology Department of China-Japan Union hospital of Jilin University from October2009to March2012,and106cases with acute cerebral infarction during the same period arechosed randomly as controls.The gende and age of the patients are similar. Relevantinformation are collected. General situation: age, gender, smoking and drinking history; Pastmedical history: hypertension, diabetes, dyslipidemia, atrial fibrillation, stroke history;clinical data: time of onset, clinical symptoms,infarct nature,clinical efficacy evaluation and prognosis; laboratory data: fasting glucose, triglycerides, total cholesterol, high densitylipoprotein cholesterol, low-density lipoprotein cholesterol; imaging examination data:lesion size and location; defibrase treatment.SPSS17.0statistical package is applied toprocess these datas. The qualitative datas are processed with χ2test,and measurement datesare processed with t-test.each index is analyzed with univariate analysis, then statisticallysignificant risk factors are included in the Logistic review model to conduct the multivariateregression analysis.The results showed that:1,The clinical features summary of the HTgroup:35cases with hemiplegia,25cases of aphasia,10cases with disturbance ofconsciousness, headache and dizziness in10cases,8cases of nausea and vomiting,5casesof common migraine, visual field defects in4cases,3cases with difficulty in swallowing,3cases of urinary incontinence,3cases with ataxia,3cases of psychiatric symptoms,unresponsive to three cases,2cases of nystagmus,1case of seizure,1case diplopia.Hemiplegia accounting for69.4%, aphasia for49.0%, disturbance of consciousness for20.4%, headache and dizziness20.4%. The clinical symptoms deteriorate after hemorrhagein21cases accounting for42.9%of the HT group, of which the degree of disturbance ofconsciousness is aggravated in8cases and hemiplegia increase in7cases, while theheadaches and dizziness are found in5cases.2.The onset time of HT: less than24hoursafter infarction in5cases, two days in5cases,3days in3cases,4to7days in13cases,8-11days in6cases,12to15days in8cases, a total of more than15days in six cases,three cases without clear time of hemorrhagic transformation. The longest was24days.Infarction within15days after the occurrence of hemorrhagic transformation accounted for87.0%.3. HT-related risk factors: these factors increased the risk of hemorrhagictransformation in cerebral infarction such as cortical infarction, large area of infarction, atrialfibrillation, cerebral embolism, diabetes and high level of LDL cholesterol (P<0.05);Thelarge area of cerebral infarction is most relevant with HT; Those factors such as smoking,alcohol consumption, stroke history,hypertension, abnormalities of triglycerides,totalcholesterol and high density lipoprotein cholesterol and treatment with defibrase have nocorrelation with HT(P>0.05).4.The49cases in HT groop is divided to12cases with PH and37cases with HI.The probability of clinical symptoms is80%in PH-2,which is higher compared with other subtypes of HT,and the difference was statistically significant(P <0.05),The efficiency of clinical treatment in PH-2is20%,while other three subtypes of PH-1, HI-2,HI-1were71.43%,72.73%,93.33%respectively.Conclusion:1.The more number ofpatients with hemiplegia aphasia and disturbance of consciousness is considered to supportthe view that the cerebral infarction after occlusion of the main artery trunk is prone to HT；2. Cerebral infarction within15days is prone to HT, and the patients alongwith the associated risk factors，unimprove or aggravated symptoms would do the CT orMRI again;3.The factors such as cortical infarct, massive cerebral infarction, atrialfibrillation, cerebral embolism, diabetes, high low-density lipoprotein cholesterol are the riskones of HT, the factors such as smoking, alcohol consumption, hypertension, triglycerides,abnormalities of total cholesterol and high density lipoprotein cholesterol, defibrasetreatment have no clear correlation with HT. Infarct patients with single or multiple riskfactors listed above should pay close attention to changes in condition and the review checkof imaging, and thrombolytic treatment programs should be used with caution;4.Theshort-term prognosis is related to the subtypes, PH-2with most nerve function defect hasless efficience in clinical treatment and the worst prognosis, while HI-1with good prognosis.