ABSTRACT
The aim of this study was to identify the prevalence of haemorrhagic transformation (HT) in patients with ischaemic stroke, and evaluate its association with medical comorbidities, stroke subtypes, premorbid medication, and long-term survival. To achieve this, we performed a retrospective analysis of 527 consecutive stroke rehabilitation patients. Of these, 102 (19.4%) developed HT. Older patients, and those with large artery strokes, had a higher risk of HT. Forty-one patients received alteplase (rtPA), of which 15 (36.6%) developed HT. A total of 129 (24.5%) patients were taking aspirin prior to their stroke and, of these, 39 (30.2%) developed HT. Twenty-three (4.36%) patients were taking vitamin k antagonists, prior to stroke, of which 14 (60.9%) developed HT. There were 102 patients (19.35%) with underlying atrial fibrillation, of whom 55 (53.9%) developed HT. Patients with known ischaemic heart disease had an increased risk of HT, and patients with HT had significantly lower total cholesterol levels (4.96 vs. 5.34) and lower LDL cholesterol levels (3.20 vs. 3.5). In conclusion, older age, atrial fibrillation, treatment with oral anticoagulants and antiplatelet medications prior to stroke, low total and LDL cholesterol, and rtPA use, are all associated with HT. Survival was not affected by the presence of HT.
Subject(s)
Intracranial Hemorrhages/physiopathology , Stroke/complications , Stroke/physiopathology , Aged , Anticoagulants/therapeutic use , Aspirin/therapeutic use , Atrial Fibrillation/drug therapy , Brain Ischemia , Female , Hemorrhage/chemically induced , Hemorrhage/physiopathology , Humans , Intracranial Hemorrhages/chemically induced , Male , Middle Aged , Platelet Aggregation Inhibitors/therapeutic use , Retrospective Studies , Singapore/epidemiology , Stroke/drug therapyABSTRACT
A 37-year-old male was admitted with history of syncope and fall leading to right temporal bone fracture with extradural haemorrhage. He underwent craniotomy and clot evacuation. Postoperatively during inpatient rehabilitation, he was progressing well with his physical and cognitive rehabilitation, when he had resting tachycardia of between 90 and 100 per minute. Investigations to rule out cardio-pulmonary and endocrine causes of tachycardia were normal. He was further investigated for suspected postural orthostatic tachycardia syndrome (POTS). A tilt table test was done which revealed rise in baseline heart rate from 90/min to 130/min on 70 with no postural drop in blood pressure. Subsequently plasma norepinephrine level in erect posture was analysed which was 721 pg/ml. A working diagnosis of POTS was made. Initially, after an increase in water intake by 1.5-2 l/day, his baseline and postural tachycardia reverted back to 76/min. He is being followed up.
