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Brain, Vol. 110, No. 1, 93-105, 1987
© 1987 Oxford University Press

research-article

THE DIAGNOSIS AND MANAGEMENT OF CEREBRAL EMBOLISM AND HAEMORRHAGIC INFARCTION WITH SEQUENTIAL COMPUTERIZED CRANIAL TOMOGRAPHY

ROBERT LAURENO1,, ROBERT W. SHIELDS, JR2 and TINA NARAYAN1,3

1From the Departments of Neurology, Washington Hospital Center and George Washington University School of Medicine Washington DC 2From the Departments of Neurology, Cleveland Metropolitan General Hospital and Case Western Reserve University School of Medicine Cleveland, Ohio, USA

Correspondence to: Correspondence to: Dr Robert Laureno, Department of Neurology, Washington Hospital Center, 110 Irving Street NW, Washington, DC 20010, USA.

Haemorrhagic infarction is typically not present immediately after cerebral embolism. Spontaneous haemorrhagic transformation evolves over several days. As a consequence, delayed CT scans are essential to exclude haemorrhagic infarction before initiating anticoagulant therapy. Sequential CT scanning can also help in the diagnosis of cerebral embolism in patients with stroke of unknown cause. In such cases the detection of haemorrhagic infarction on a delayed scan suggests an embolic mechanism. The evolution of haemorrhagic infarction on sequential CT scans graphically demonstrates the dynamic nature of this lesion and thereby indicates why serious brain haemorrhage may result from anticoagulation immediately after cerebral embolism.

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Received August 12, 1985. Revised March 11, 1986. Accepted April 8, 1986.

3 Present address: 6607 Travis, Houston, Texas 77030, USA.


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