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Table of Contents
Symptoms
Causes
tPA Window
Diagnosis
Treatment
Hemorrhagic conversion (HC) is bleeding in the brain that can occur soon after anischemic stroke—that is, one that happens because of a blocked artery to the brain. HC, also known as hemorrhagic transformation, is usually a minor complication and only requires monitoring, however, in some cases, it can become life-threatening.
Hemorrhagic conversion can occur naturally or be a consequence oftissue plasminogen activator(tPA)—the go-to emergency stroke treatment.
This article discusses the causes, symptoms, diagnosis, and treatment of hemorrhagic conversion. It also covers who is most at risk and why there are circumstances under which both using tPA and not using it can cause HC.
Deagreez / Getty Images
Why Sudden Strokes Occur
Hemorrhagic Conversion Symptoms
Hemorrhagic transformations usually happen one or two weeks after a stroke begins. In about 9% of cases, HC happens within 24 hours.
Bleeding in the brain causes numerous cognitive and physical symptoms, including:
Depending on how soon after the stroke HC occurs, symptoms may seem like an effect of the original stroke rather than a separate event.
Symptoms often progress gradually over the course of minutes or hours.Other times, the stroke survivor’s condition may suddenly and rapidly decline as the hemorrhagic conversion takes place.
That said, there are many cases in which there are no signs that hemorrhagic conversion is occurring. The bleed may not be detected until acomputed tomography (CT) scan of the brainis done.
In a study of 1,789 people who had ischemic strokes, only 1.4% (25 people) experienced HC with symptoms, while 8% (143 people) experienced HC with no symptoms at all.
Complications
During a hemorrhagic conversion, blood pools within the brain and between brain tissues and theskull. This preventsoxygencirculating in the blood from reaching the brain and causes tissue damage.
As blood collects, it also places immensepressure on the brain, heightening the degree of brain damage.
Both of these can have significant effects. Related complications vary from person to person.
The first three months following a brain bleed (hemorrhage) are critical, as between 48% and 91% ofrecoverytakes place during this time.It’s also during the first few months of a stroke that doctors and patients must be on high alert for other complications, including pneumonia and a second stroke.
Most notably, hemorrhagic transformation carries a significantrisk of death. Approximately 40% of people die within one month of their brain hemorrhage and 54% of people die within one year.
Those who survive are likely to have some form of physical or cognitive disability that can last for six months or more.
Possible long-term disabilities following hemorrhagic transformation include:
Between 12% and 39% of people maintain long-termfunctional independenceafter their brain hemorrhage. This means that they are able to continue their lives without a permanent need for help with everyday-life tasks, such as self-care, communication, movement, and problem-solving.
Research indicates that whether or not HC symptoms were initially present makes no difference in long-term outcomes or survival past one year.
RecapHemorrhagic conversion usually happens within a week or two of a stroke. It can cause symptoms such as headache, one-sided weakness, and loss of consciousness. Because HC deprives the brain of oxygen and puts pressure on the brain, physical or cognitive disability and even death can occur.
Recap
Hemorrhagic conversion usually happens within a week or two of a stroke. It can cause symptoms such as headache, one-sided weakness, and loss of consciousness. Because HC deprives the brain of oxygen and puts pressure on the brain, physical or cognitive disability and even death can occur.
Hemorrhagic Stroke: How to Spot and Prevent It
Restoring blood flow (recanalization) is the immediate goal of stroke treatment. It may happen on its own in the hours or days after the stroke as the damaged tissues heal, or with the help of athrombolytic(namely, tPA).
Thrombolytics are drugs that dissolve the blood clot that is causing the stroke. They quickly get blood flowing to the brain to prevent as muchbrain damageas possible.
Unfortunately, damaged blood vessels can rupture and bleed into the brain when blood starts to pour back in. This is hemorrhagic conversion.
Between 10% and 15% of people who have an ischemic stroke develop hemorrhagic conversion.
How soon HC occurs following an ischemic stroke depends on several factors, including:
Risk Factors
Your risk of hemorrhagic conversion increases with your risk of ischemic stroke. You are more likely to have an ischemic stroke if you have one or more of the following conditions:
Not everyone who has an ischemic stroke develops HC, though. The older you are, the more likely you are to develop HC. Your risk is also higher if:
Lastly, the risk of hemorrhagic conversion is especially high in the hours and days following thrombolysis—the process in which blood flow to the brain is restored using a thrombolytic drug.
Doctors must weigh risk factors quickly and carefully to keep the risk of hemorrhagic conversion as low as possible when treating a stroke patient.
Weight and Your Stroke Risk
Window for Using tPA
Restoring blood flow (recanalization) is the immediate goal of stroke treatment. It may happen on its own in the hours or days after the stroke as the damaged tissues heal, or with the help of athrombolytic(tissue plasminogen activator, or tPA).
Tissue plasminogen activator is the mainstay of emergency treatment for ischemic stroke. It is highly regarded as a life-saving treatment that restores blood flow and prevents further tissue damage.
One study found that people who were given alteplase were 37% less likely to die from stroke-related complications than people who weren’t. Researchers also found that those who received the treatment were more independent and experienced less disability in the five years after their stroke than those who did get the drug.
Furthermore, approximately 15% of ischemic stroke survivors who are not given thrombolytic treatment develop hemorrhagic conversion within 14 days of their stroke.
The benefits are impressive. But there is a catch: Alteplase is only safe and effective when given within three hours of the first stroke symptoms appearing.
Around 80% of people who have an ischemic stroke cannot be given tPA, often because they do not get to the hospital quick enough.If you think you could be having a stroke, don’t wait. Call 911 immediately so that treatment can begin as soon as medics arrive.
Note that risk factors foruncontrolled bleedingin the brain can also make you ineligible to receive tPA treatment. These include:
RecapTreatment with tPA can drastically improve a person’s immediate and long-term chance of survival along with their quality of life after a stroke.However, it must be given within three hours of the event. If given too late, it can increase the risk of hemorrhagic conversion.
Treatment with tPA can drastically improve a person’s immediate and long-term chance of survival along with their quality of life after a stroke.However, it must be given within three hours of the event. If given too late, it can increase the risk of hemorrhagic conversion.
Coping With Stroke
According to the American Heart Association, those who are given alteplase should be closely monitored for at least 24 hours in theICUor stroke unit.
During this time, doctors will keep close tabs on the patient’s blood pressure and routinely check for nausea or vomiting, vision changes, trouble speaking, confusion, or other signs that their neurological state is worsening.
Should any such changes occur, the patient will immediately be taken for a CT scan to check for a brain hemorrhage.
And because hemorrhagic transformations do not always cause symptoms, all patients who receive alteplase should be given several CT scans throughout the first 24 hours to monitor for the condition.
Keep in mind that there is a possibility of HC occurring after a stroke patient is sent home from the hospital as well. Stroke survivors need to monitor their symptoms closely and call 911 if they develop any symptoms that resemble HC.
If a patient returns to the hospital with HC symptoms, doctors will follow the same protocol that was used to monitor for HC in the first 24 hours after their stroke.
Neurological Symptoms and Diagnosis
Hemorrhagic Conversion Treatment
Hemorrhagic conversion is treated like any other brain hemorrhage, with the primary focuses being:
Next, the focus turns to lowering blood pressure and stopping the pool of blood (hematoma) from expanding.
If blood flow has already returned, doctors will try to keep their patient’s blood pressure below 180/105.Blood pressure-lowering (antihypertensive) medicationsthat may be used to accomplish this includeangiotensin-converting enzyme (ACE) inhibitors,beta blockers, andcalcium channel blockers.
If complete recanalization has not occurred, blood pressure will need to be kept slightly higher to ensure enough oxygen reaches the brain. Doctors may use a blood vessel-narrowing medication likenorepinephrineto raise blood pressure at a controlled rate.
To relieve pressure on the brain, a type of surgery calledhematoma evacuationmay be necessary to suction up the blood. How the surgeon performs this procedure depends on the size of the hematoma.
The portion of the skull that is removed during a hemicraniectomy may either be replaced at the end of the surgery or in a separate surgery months later, when the patient has recovered. This separate surgery is known as a cranioplasty.
Throughout the treatment process, doctors and their patients will need to carefully weigh the risks and benefits of each treatment and only proceed with those that improve the patient’s chance of survival.
While some people may be able to return home within days of their hemorrhagic conversion, others may need care (short- or long-term) in arehabilitation facility.
RecapAn IV transfusion of a medication that helps clot blood is immediately given when a hemorrhagic conversion is diagnosed. Blood pressure is managed with medication, and surgery may be necessary to prevent blood from continuing to pool in the brain and relieve pressure.
An IV transfusion of a medication that helps clot blood is immediately given when a hemorrhagic conversion is diagnosed. Blood pressure is managed with medication, and surgery may be necessary to prevent blood from continuing to pool in the brain and relieve pressure.
Stroke Treatment: Before, During, and After
Summary
Hemorrhagic conversion occurs when blood vessels in the brain rupture after blood flow is restored to the brain after a stroke. HC can cause stroke-like symptoms, as well as complications that can have lasting effects, including disability and death.
The risk of hemorrhagic conversion increases drastically the longer stroke treatment is delayed. But while it can happen to people who are not given tPA—the standard emergency drug treatment—it can also happen to those who get it too late (i.e., more than three hours after their stroke started).
Doctors carefully monitor for HC while stroke patients are in the hospital, and patients who experience symptoms in the week or two after their stroke—even if while back at home—should seek immediate medical attention.
A Word From Verywell
“Time is brain” is a phrase meant to convey that every minute that passes during a stroke, more brain cells die and the risk of brain hemorrhage increases.
Know thesigns of strokeand call 911 if you notice or even suspect them. Never drive yourself to the hospital.
Medics will be able to start treatment immediately, and some mobile stroke units can even take a CT scan of your brain and begin tPA treatment en route to the hospital.
Life After Stroke
22 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Choi PMC, Ly JV, Srikanth V, et al.Differentiating between hemorrhagic infarct and parenchymal intracerebral hemorrhage.Radio Res Pract. 2012 Apr;2012(1):1-11. doi:10.1155/2012/475497American Association of Neurological Surgeons.Intracerebral hemorrhage.Rymer MM.Hemorrhagic stroke: intracerebral hemorrhage.Mo Med; 108(1):50-54.Lei C, Wu B, Liu M, Chen Y.Asymptomatic hemorrhagic transformation after acute ischemic stroke: Is it clinically innocuous?.J Stroke Cerebro Dis. 2014 Dec;23(10):2767-2772. doi:10.1016/j.jstrokecerebrovasdis.2014.06.024Lee KB, Lim SH, Kim KH, et al.Six-month functional recovery of stroke patients: a multi-time-point study.Int J Rehabil Res. 2015 May;38(2):173-180. doi:10.1097/MRR.0000000000000108An SJ, Kim TJ, Yoon BW.Epidemiology, risk Factors, and clinical features of intracerebral hemorrhage: an update.J Stroke. 2017 Jan;19(1):3-10. doi:10.5853/jos.2016.00864Tish M, Geerling J.The brain and the bladder: forebrain control of urinary (in)continence.Front Physiol. 2020 Jul;11(1):1-8. doi:10.3389/fphys.2020.00658Shaker R, Geenen JE.Management of dysphagia in stroke patients.Gastroenterol Hepatol (N Y); 7(5):308-332.Stone J, Willey J, Keyrouz S, et al.Therapies for hemorrhagic transformation in acute ischemic stroke.Curr Treat Options Neurol. 2017 Jan;19(1):1. doi:10.1007/s11940-017-0438-5de Andrade JBC, Mohr JP, Lima FO, et al.Predictors of hemorrhagic transformation after acute ischemic stroke based on the experts' opinion.Arq Neuro Psiquitar. 2020 Jul;78(7):1-7. doi:10.1590/0004-282X20200008National Heart, Lung, and Blood Institute.Stroke.Öcek L, Güner D, Uludağ İF, Tiftikçioğlu Bİ, Zorlu Y.Risk factors for hemorrhagic transformation in patients with acute middle cerebral artery infarction.Noro Psikiyatr Ars. 2015 Dec;52(4):342-345. doi:10.5152/npa.2015.8792National Institute of Neurological Disorders and Stroke.Tissue plasminogen activator for acute ischemic stroke (Alteplase, Activase).Yaghi S, Willey J, Cucchiara B, et al.Treatment and outcome of hemorrhagic transformation after intravenous alteplase in acute ischemic stroke.Stroke. 2017 Nov;48(12):343-361. doi:10.1161/STR.0000000000000152Muruet W, Rudd A, Wolfe CDA, Douiri A.Long-term survival after intravenous thrombolysis for ischemic stroke: A propensity score-matched cohort with up to 10-year follow-up.Stroke. 2018 Feb;49(3):607-613. doi:10.1161/STROKEAHA.117.019889Kalinin MN, Khasanova DR, Ibatullin MM.The hemorrhagic transformation index score: a prediction tool in middle cerebral artery ischemic stroke.BMC Neurology. 2017 Sep;17(1):1-16. doi:10.1186/s12883-017-0958-3Jauch E, Saver J, Adams H, et al.Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2013 Mar;44(3):870-947. doi:10.1161/STR.0b013e318284056aLászló J, Hortobágyi T.Hemorrhagic transformation of ischemic stroke.Vascul Dis Ther. 2017 Jun;2(4):1-25. doi:10.15761/VDT.1000130Fugate JE, Rabinstein AA.Absolute and relative contraindications to IV rt-PA for acute ischemic stroke.Neurohospitalist. 2015 Jul;5(3):110-121. doi:10.1177/1941874415578532American Heart Association/American Stroke Association.Treatment and outcome of hemorrhagic transformation after intravenous alteplase in acute ischemic stroke.Vitt J, Trillianes M, Hemphill III J.Management of blood pressure during and after recanalization therapy for acute ischemic stroke.Front Neurol. 2019 Feb;10(1):1-13. doi:10.3389/fneur.2019.00138Sandset EC, Anderson C, Bath P, et al.European Stroke Organization (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage.Euro Stroke J. 2021 May;6(2):1-42. doi:10.1177/23969873211012133
22 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Choi PMC, Ly JV, Srikanth V, et al.Differentiating between hemorrhagic infarct and parenchymal intracerebral hemorrhage.Radio Res Pract. 2012 Apr;2012(1):1-11. doi:10.1155/2012/475497American Association of Neurological Surgeons.Intracerebral hemorrhage.Rymer MM.Hemorrhagic stroke: intracerebral hemorrhage.Mo Med; 108(1):50-54.Lei C, Wu B, Liu M, Chen Y.Asymptomatic hemorrhagic transformation after acute ischemic stroke: Is it clinically innocuous?.J Stroke Cerebro Dis. 2014 Dec;23(10):2767-2772. doi:10.1016/j.jstrokecerebrovasdis.2014.06.024Lee KB, Lim SH, Kim KH, et al.Six-month functional recovery of stroke patients: a multi-time-point study.Int J Rehabil Res. 2015 May;38(2):173-180. doi:10.1097/MRR.0000000000000108An SJ, Kim TJ, Yoon BW.Epidemiology, risk Factors, and clinical features of intracerebral hemorrhage: an update.J Stroke. 2017 Jan;19(1):3-10. doi:10.5853/jos.2016.00864Tish M, Geerling J.The brain and the bladder: forebrain control of urinary (in)continence.Front Physiol. 2020 Jul;11(1):1-8. doi:10.3389/fphys.2020.00658Shaker R, Geenen JE.Management of dysphagia in stroke patients.Gastroenterol Hepatol (N Y); 7(5):308-332.Stone J, Willey J, Keyrouz S, et al.Therapies for hemorrhagic transformation in acute ischemic stroke.Curr Treat Options Neurol. 2017 Jan;19(1):1. doi:10.1007/s11940-017-0438-5de Andrade JBC, Mohr JP, Lima FO, et al.Predictors of hemorrhagic transformation after acute ischemic stroke based on the experts' opinion.Arq Neuro Psiquitar. 2020 Jul;78(7):1-7. doi:10.1590/0004-282X20200008National Heart, Lung, and Blood Institute.Stroke.Öcek L, Güner D, Uludağ İF, Tiftikçioğlu Bİ, Zorlu Y.Risk factors for hemorrhagic transformation in patients with acute middle cerebral artery infarction.Noro Psikiyatr Ars. 2015 Dec;52(4):342-345. doi:10.5152/npa.2015.8792National Institute of Neurological Disorders and Stroke.Tissue plasminogen activator for acute ischemic stroke (Alteplase, Activase).Yaghi S, Willey J, Cucchiara B, et al.Treatment and outcome of hemorrhagic transformation after intravenous alteplase in acute ischemic stroke.Stroke. 2017 Nov;48(12):343-361. doi:10.1161/STR.0000000000000152Muruet W, Rudd A, Wolfe CDA, Douiri A.Long-term survival after intravenous thrombolysis for ischemic stroke: A propensity score-matched cohort with up to 10-year follow-up.Stroke. 2018 Feb;49(3):607-613. doi:10.1161/STROKEAHA.117.019889Kalinin MN, Khasanova DR, Ibatullin MM.The hemorrhagic transformation index score: a prediction tool in middle cerebral artery ischemic stroke.BMC Neurology. 2017 Sep;17(1):1-16. doi:10.1186/s12883-017-0958-3Jauch E, Saver J, Adams H, et al.Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2013 Mar;44(3):870-947. doi:10.1161/STR.0b013e318284056aLászló J, Hortobágyi T.Hemorrhagic transformation of ischemic stroke.Vascul Dis Ther. 2017 Jun;2(4):1-25. doi:10.15761/VDT.1000130Fugate JE, Rabinstein AA.Absolute and relative contraindications to IV rt-PA for acute ischemic stroke.Neurohospitalist. 2015 Jul;5(3):110-121. doi:10.1177/1941874415578532American Heart Association/American Stroke Association.Treatment and outcome of hemorrhagic transformation after intravenous alteplase in acute ischemic stroke.Vitt J, Trillianes M, Hemphill III J.Management of blood pressure during and after recanalization therapy for acute ischemic stroke.Front Neurol. 2019 Feb;10(1):1-13. doi:10.3389/fneur.2019.00138Sandset EC, Anderson C, Bath P, et al.European Stroke Organization (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage.Euro Stroke J. 2021 May;6(2):1-42. doi:10.1177/23969873211012133
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Choi PMC, Ly JV, Srikanth V, et al.Differentiating between hemorrhagic infarct and parenchymal intracerebral hemorrhage.Radio Res Pract. 2012 Apr;2012(1):1-11. doi:10.1155/2012/475497American Association of Neurological Surgeons.Intracerebral hemorrhage.Rymer MM.Hemorrhagic stroke: intracerebral hemorrhage.Mo Med; 108(1):50-54.Lei C, Wu B, Liu M, Chen Y.Asymptomatic hemorrhagic transformation after acute ischemic stroke: Is it clinically innocuous?.J Stroke Cerebro Dis. 2014 Dec;23(10):2767-2772. doi:10.1016/j.jstrokecerebrovasdis.2014.06.024Lee KB, Lim SH, Kim KH, et al.Six-month functional recovery of stroke patients: a multi-time-point study.Int J Rehabil Res. 2015 May;38(2):173-180. doi:10.1097/MRR.0000000000000108An SJ, Kim TJ, Yoon BW.Epidemiology, risk Factors, and clinical features of intracerebral hemorrhage: an update.J Stroke. 2017 Jan;19(1):3-10. doi:10.5853/jos.2016.00864Tish M, Geerling J.The brain and the bladder: forebrain control of urinary (in)continence.Front Physiol. 2020 Jul;11(1):1-8. doi:10.3389/fphys.2020.00658Shaker R, Geenen JE.Management of dysphagia in stroke patients.Gastroenterol Hepatol (N Y); 7(5):308-332.Stone J, Willey J, Keyrouz S, et al.Therapies for hemorrhagic transformation in acute ischemic stroke.Curr Treat Options Neurol. 2017 Jan;19(1):1. doi:10.1007/s11940-017-0438-5de Andrade JBC, Mohr JP, Lima FO, et al.Predictors of hemorrhagic transformation after acute ischemic stroke based on the experts' opinion.Arq Neuro Psiquitar. 2020 Jul;78(7):1-7. doi:10.1590/0004-282X20200008National Heart, Lung, and Blood Institute.Stroke.Öcek L, Güner D, Uludağ İF, Tiftikçioğlu Bİ, Zorlu Y.Risk factors for hemorrhagic transformation in patients with acute middle cerebral artery infarction.Noro Psikiyatr Ars. 2015 Dec;52(4):342-345. doi:10.5152/npa.2015.8792National Institute of Neurological Disorders and Stroke.Tissue plasminogen activator for acute ischemic stroke (Alteplase, Activase).Yaghi S, Willey J, Cucchiara B, et al.Treatment and outcome of hemorrhagic transformation after intravenous alteplase in acute ischemic stroke.Stroke. 2017 Nov;48(12):343-361. doi:10.1161/STR.0000000000000152Muruet W, Rudd A, Wolfe CDA, Douiri A.Long-term survival after intravenous thrombolysis for ischemic stroke: A propensity score-matched cohort with up to 10-year follow-up.Stroke. 2018 Feb;49(3):607-613. doi:10.1161/STROKEAHA.117.019889Kalinin MN, Khasanova DR, Ibatullin MM.The hemorrhagic transformation index score: a prediction tool in middle cerebral artery ischemic stroke.BMC Neurology. 2017 Sep;17(1):1-16. doi:10.1186/s12883-017-0958-3Jauch E, Saver J, Adams H, et al.Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2013 Mar;44(3):870-947. doi:10.1161/STR.0b013e318284056aLászló J, Hortobágyi T.Hemorrhagic transformation of ischemic stroke.Vascul Dis Ther. 2017 Jun;2(4):1-25. doi:10.15761/VDT.1000130Fugate JE, Rabinstein AA.Absolute and relative contraindications to IV rt-PA for acute ischemic stroke.Neurohospitalist. 2015 Jul;5(3):110-121. doi:10.1177/1941874415578532American Heart Association/American Stroke Association.Treatment and outcome of hemorrhagic transformation after intravenous alteplase in acute ischemic stroke.Vitt J, Trillianes M, Hemphill III J.Management of blood pressure during and after recanalization therapy for acute ischemic stroke.Front Neurol. 2019 Feb;10(1):1-13. doi:10.3389/fneur.2019.00138Sandset EC, Anderson C, Bath P, et al.European Stroke Organization (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage.Euro Stroke J. 2021 May;6(2):1-42. doi:10.1177/23969873211012133
Choi PMC, Ly JV, Srikanth V, et al.Differentiating between hemorrhagic infarct and parenchymal intracerebral hemorrhage.Radio Res Pract. 2012 Apr;2012(1):1-11. doi:10.1155/2012/475497
American Association of Neurological Surgeons.Intracerebral hemorrhage.
Rymer MM.Hemorrhagic stroke: intracerebral hemorrhage.Mo Med; 108(1):50-54.
Lei C, Wu B, Liu M, Chen Y.Asymptomatic hemorrhagic transformation after acute ischemic stroke: Is it clinically innocuous?.J Stroke Cerebro Dis. 2014 Dec;23(10):2767-2772. doi:10.1016/j.jstrokecerebrovasdis.2014.06.024
Lee KB, Lim SH, Kim KH, et al.Six-month functional recovery of stroke patients: a multi-time-point study.Int J Rehabil Res. 2015 May;38(2):173-180. doi:10.1097/MRR.0000000000000108
An SJ, Kim TJ, Yoon BW.Epidemiology, risk Factors, and clinical features of intracerebral hemorrhage: an update.J Stroke. 2017 Jan;19(1):3-10. doi:10.5853/jos.2016.00864
Tish M, Geerling J.The brain and the bladder: forebrain control of urinary (in)continence.Front Physiol. 2020 Jul;11(1):1-8. doi:10.3389/fphys.2020.00658
Shaker R, Geenen JE.Management of dysphagia in stroke patients.Gastroenterol Hepatol (N Y); 7(5):308-332.
Stone J, Willey J, Keyrouz S, et al.Therapies for hemorrhagic transformation in acute ischemic stroke.Curr Treat Options Neurol. 2017 Jan;19(1):1. doi:10.1007/s11940-017-0438-5
de Andrade JBC, Mohr JP, Lima FO, et al.Predictors of hemorrhagic transformation after acute ischemic stroke based on the experts' opinion.Arq Neuro Psiquitar. 2020 Jul;78(7):1-7. doi:10.1590/0004-282X20200008
National Heart, Lung, and Blood Institute.Stroke.
Öcek L, Güner D, Uludağ İF, Tiftikçioğlu Bİ, Zorlu Y.Risk factors for hemorrhagic transformation in patients with acute middle cerebral artery infarction.Noro Psikiyatr Ars. 2015 Dec;52(4):342-345. doi:10.5152/npa.2015.8792
National Institute of Neurological Disorders and Stroke.Tissue plasminogen activator for acute ischemic stroke (Alteplase, Activase).
Yaghi S, Willey J, Cucchiara B, et al.Treatment and outcome of hemorrhagic transformation after intravenous alteplase in acute ischemic stroke.Stroke. 2017 Nov;48(12):343-361. doi:10.1161/STR.0000000000000152
Muruet W, Rudd A, Wolfe CDA, Douiri A.Long-term survival after intravenous thrombolysis for ischemic stroke: A propensity score-matched cohort with up to 10-year follow-up.Stroke. 2018 Feb;49(3):607-613. doi:10.1161/STROKEAHA.117.019889
Kalinin MN, Khasanova DR, Ibatullin MM.The hemorrhagic transformation index score: a prediction tool in middle cerebral artery ischemic stroke.BMC Neurology. 2017 Sep;17(1):1-16. doi:10.1186/s12883-017-0958-3
Jauch E, Saver J, Adams H, et al.Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2013 Mar;44(3):870-947. doi:10.1161/STR.0b013e318284056a
László J, Hortobágyi T.Hemorrhagic transformation of ischemic stroke.Vascul Dis Ther. 2017 Jun;2(4):1-25. doi:10.15761/VDT.1000130
Fugate JE, Rabinstein AA.Absolute and relative contraindications to IV rt-PA for acute ischemic stroke.Neurohospitalist. 2015 Jul;5(3):110-121. doi:10.1177/1941874415578532
American Heart Association/American Stroke Association.Treatment and outcome of hemorrhagic transformation after intravenous alteplase in acute ischemic stroke.
Vitt J, Trillianes M, Hemphill III J.Management of blood pressure during and after recanalization therapy for acute ischemic stroke.Front Neurol. 2019 Feb;10(1):1-13. doi:10.3389/fneur.2019.00138
Sandset EC, Anderson C, Bath P, et al.European Stroke Organization (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage.Euro Stroke J. 2021 May;6(2):1-42. doi:10.1177/23969873211012133
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