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Brain Trauma Stroke
early ischaemic changes on CT and acute DWI restrictions has not been well disruption, had subsequent ICH with 100% specificity.
51,52
Currently, there
established,
43,44
large DWI lesions within six hours after onset have been are no validated exclusion criteria for thrombolysis on the basis of MRI alone.
reported as a predictor for subsequent symptomatic ICH.
45,46
In the DEFUSE Nevertheless, MRI-based trials beyond three hours showed lower risk than
trial, the OR for symptomatic ICH was 1.42 (95% CI 1.13–1.78) per 10ml CT-based trials for symptomatic ICH.
4
increase in DWI lesion volume.
45
Conclusions
Hypointense lesions on T2*-weighted MRI are thought to represent The evidence for the clinical effectiveness of MRI-based IV thrombolysis
‘microbleeds’.
47
It is uncertain whether patients with these lesions are at beyond three hours (and now beyond 4.5 hours, following the publication
greater risk of post-thrombolytic ICH, but for patients with few lesions this of the ECASS 3 study) has been limited. There is strong biological evidence
does not seem to be the case.
48–50
More recently, some preliminary reports that the use of imaging techniques, particularly MR using PWI–DWI
showed that patients with parenchymal enhancement on T1-weighted MRI mismatch, may allow the selection of patients likely to be responsive to
scan immediately after thrombolysis, which represents blood–brain barrier thrombolytic therapy beyond these currently established time limits. ■
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60 EUROPEAN NEUROLOGICAL REVIEW
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