Types of parenchymal hemorrhage and clinical correlation
Of the 33 patients with ICH, 5 (15.2%) had parenchymal hemorrhages with mass effect and herniation. These images were particularly notable as all 5 patients also had radiographic evidence of diffuse hypoxic ischemic injury and brain swelling and a 100% mortality rate (Table 1). All 5 patients had received therapeutic anticoagulation, 3 (60%) for a high D-dimer and 2 (40%) for a known thrombus. Imaging evidence of hemorrhage was seen on median day 22 (IQR 19–28) of hospitalization. Among these 5 patients, 4 (80%) patients had an anti-factor Xa or PTT above the upper limit of normal within 72 hours prior to the bleed (Table 2). Based on review by the study neuroradiologist, all of these hemorrhages were thought to be primary ICH rather than hemorrhagic conversion of ischemic stroke.
Of the other 28 patients with ICH, 7 (25%) had punctate hemorrhages, mostly involving the cortex, 17 (60.7%) had small hemorrhages, and 4 (14.3%) had a large single site of hemorrhage without evidence of herniation (Table 1). Based on review by the study neuroradiologist, 26/28 (92.9%) bleeds were considered to have suffered hemorrhagic conversion of an ischemic infarct. Mortality was 8/24 (33.3%) of the patients with punctate and small hemorrhages and 1/4 (25%) of the patients with large single hemorrhages without herniation.