Q: Presence of leukoaraiosis increases the risk of intracerebral hemorrhage after intravenous thrombolysis for acute ischemic stroke. What is leukoaraiosis?


Answer: Leukoaraiosis is also known as white matter hyperintensities. Radiologically, they appear as decreased density on CT and increased signal intensity on T2/FLAIR sequences on MRI. Leukoaraiosis is a nonspecific finding by itself  but may be a manifestation of underlying diseased vessels and frequently seen in patients with hypertension, tobacco use, diabetes, ischemic heart disease etc. Various factors increase the risk of intracerebral hemorrhage after intravenous thrombolysis for acute ischemic stroke. Intensivists are usually the first line of caregivers beside neurologists to get call  for any complication after intravenous thrombolysis for acute ischemic stroke. These factors include presence of leukoaraiosis prior to thrombolysis, stroke severity, age, history of heart disease particularly atrial fibrillation, uncontrolled diabetes, chronic kidney disease (CKD), uncontrolled blood pressure after thrombolysis, thrombocytopenia, on antiplatelet or warfarin therapy etc.




References:

1. Neumann-Haefelin T, Hoelig S, Berkefeld J, et al. Leukoaraiosis is a risk factor for symptomatic intracerebral hemorrhage after thrombolysis for acute stroke. Stroke 2006; 37:2463. 

2. Palumbo V, Boulanger JM, Hill MD, et al. Leukoaraiosis and intracerebral hemorrhage after thrombolysis in acute stroke. Neurology 2007; 68:1020

3. Curtze S, Haapaniemi E, Melkas S, et al. White Matter Lesions Double the Risk of Post-Thrombolytic Intracerebral Hemorrhage. Stroke 2015; 46:2149.