Focal Fluid-Attenuated Inversion Recovery Hyperintensity Within Acute Diffusion-Weighted Imaging Lesions Is Associated With Symptomatic Intracerebral Hemorrhage After Thrombolysis

Background and Purpose-We investigated whether focal hyperintensity on fluid-attenuated inversion recovery image within acute infarcts is associated with symptomatic intracerebral hemorrhage (SICH) after thrombolysis. Methods-Patients with acute ischemic stroke who underwent MRI screening before thrombolysis were enrolled. The presence of focal fluid-attenuated inversion recovery hyperintensity within acute infarcts did not preclude thrombolysis. SICH was defined as hemorrhagic transformation with any neurological decline (SICH-1) or with an increase in National Institutes of Health Stroke Scale of >= 4 (SICH-2) within 48 hours. Results-Among 88 included patients, focal fluid-attenuated inversion recovery hyperintensity within acute infarct lesions was observed in 27 (30.7%) patients. Multivariate analysis showed that focal fluid-attenuated inversion recovery hyperintensity was independently associated with SICH-1 (OR, 13.64; 95% CI, 1.51 to 123.28) and SICH-2 (OR, 10.44; 95% CI, 1.11 to 98.35). Conclusion-The presence of focal fluid-attenuated inversion recovery hyperintensity within acute infarcts may increase the risk of symptomatic intracerebral hemorrhage after thrombolysis. (Stroke. 2008; 39: 3424-3426.)