Images in Clinical Medicine
Hemorrhagic Transformation of a Cerebral Infarct
N Engl J Med 2001; 345:1105October 11, 2001
- Article
Figure 1 A 74-year-old woman presented to the emergency department two hours after the development of slurred speech and weakness of the left arm and leg. The blood pressure was 154/66 mm Hg, and the platelet count was 203,000 per cubic millimeter. A neurologic examination revealed a right-gaze preference, left hemiplegia, and a left hemisensory deficit. Computed tomography (CT) of the brain revealed no abnormalities, and the results of coagulation studies were normal. Tissue plasminogen activator was administered intravenously over a one-hour period for acute ischemia of the right middle cerebral artery. The blood pressure remained below 185/110 mm Hg during the infusion. Nine hours later, the patient became stuporous. A CT scan showed hemorrhagic infarction of the right frontal lobe. Blood extended into the lateral ventricles. She was treated with intermittent infusions of mannitol for one day. Although she regained a normal level of consciousness four days later, a dense left hemiparesis and sensory deficit persisted. She was discharged to a rehabilitation facility. Six weeks later, her neurologic deficits had not improved substantially.
Scott Silliman, M.D.
Michael Blum, M.D.
University of Florida Health Sciences Center, Jacksonville, FL 32209-6511
