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Thursday, December 18, 2014
Stroke - ischemic or hemorrhagic- CT & MRI
My sister 33 years old sufferred an stroke. The report of CT and MRI is as below : 1) CT ( 03/05/07 - 0700 hrs)- Right temporoparietal large area in posterior trunk of MCA supply territory appears hypodense with loss of sulci-gyri and grey-white differentiation suggestive of developing infarct ? Embolic-probably responsible for symptomatology. Right basal ganglia also involved.
2) MRI ( 10/05/07) - Whole of right MCA supply territory including perforators supply region in a well defined manner showing heterogenous hyperintensity on T2/FLAIR, sulcal effacement, gyral swelling and partial loss of grey-white differentiation with restricted diffussion. Gyri are showing heterogeneous irregular hyperintensity on T1 with bright T1 hyperintense right basal ganglia, not blooming on gradient imaging suggestive of Right MCA haemorrhagic infarct - probably responsible for symptomatology.
As a layman , what I understand is that CT report is pointing blame to stroke caused by EMBOLUS, whereas MRI report blames the stoke on HAEMORRAGE.
The doctors treated her on CLEXANE for full 9 days before stopping the same.
Does it mean that she did not receive the right treatment for first 9 days. Because when the stroke is haemorragic , anticogulants should not be administered at all because the same increases haemorrage.
PLEASE HELP ME SO THAT CORRECT TREATMENT CAN BE STARTED FOR THE YOUNG LADY. HER LEFT SIDE HAS BECOME PARALYTIC WITH SPEECH FUNCTION ALSO LOST.
From the information provided, it is my supposition that the stroke was ischemic with hemorrhagic transformation.
When blood supply is interrupted to part of the brain (usually by a blood clot blocking an artery feeding that part of the brain) there is irreversible damage--an ischemic stroke. With the stroke damage, we often see some minor bleeding (into some or all of the damaged territory)--we refer to this as hemorrhagic transformation, and it occurs in 30-60 percent of strokes (higher likelihood of this happening with bigger strokes).
Please note that these are general comments, and that imaging results need to be put into context of the patient's clinical history and exam.
I will add that one cannot usually determine if the cause of stroke is embolic from imaging alone. If there was some reason to believe that there was an embolic event (often this is determined by echocardiogram, EKG findings. or review of past medical history), then anticoagulation may have been appropriate treatment. Once a hemorrhagic transformation is discovered, it may be prudent to stop the anticoagulation for fear that bleeding into the stroke could occur and cause clinical worsening.
All of this should be discussed with the treating physician.
Brett Kissela, MD
Assistant Professor of Neurology
Director, Neurology Residency Program
College of Medicine
University of Cincinnati