"severe strokes (NIHSS >14)"
"The presence of high T2 signal in the sulci following reperfusion on post contrast FLAIR (HARM) has been shown to predict haemorrhagic transformation 17. Higher permeability in perfusion imaging, low CBV, low ADC and high FLAIR ratio between infarcted and normal white matter, and sulcal and vessel FLAIR hyperintensity are associated with higher risk of haemorrhagic transformation 17."
Expected headings
"CT angiography"
"Video"
"The term haemorrhagic transformation is somewhat variably used and collectively refers to two different processes, which have different incidence, appearance and prognostic implications. These are:"
"A commonly used classification system was developed for the European Cooperative Acute Stroke Study (ECASS) trials (ECASS I, II and III 2,15,16), which divides haemorrhagic transformation into four subtypes 9:"
"The rates of haemorrhagic transformation of ischaemic strokes have been variably reported, but generally over half of all cerebral infarcts at some stage develop some haemorrhagic component. The majority of haemorrhagic transformation after stroke (89%) is petechial haemorrhages; a minority (11%) haematomas 5,6. Indeed, one 2024 study of almost 1400 patients demonstrated that the most common type (per the Heidelberg bleeding classification) of intracranial haemorrhage was HI1 (~45%), followed by HI2 (~30%) and subarachnoid haemorrhage (~30%), with PH2 representing only ~3% 14. In patients with symptomatic ICH (33%), the most common type was HI2 (~50%) 14."