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March 2011

Thrombolysis-Associated Symptomatic Intracerebral Hemorrhage—Reply

Author Affiliations

Author Affiliations: Departments of Emergency Medicine (Drs Goldstein and Marrero), Neurology (Drs Masrur, Pervez, Abdullah, Rosand, and Schwamm and Ms Oleinik), and Hematology (Dr Dzik), Massachusetts General Hospital, Boston; Department of Radiology, Mount Sinai Medical Center, Miami Beach, Florida (Dr Barrocas); and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (Dr Smith).

Arch Neurol. 2011;68(3):395-399. doi:10.1001/archneurol.2011.10

In reply

We would like to thank the authors for their comments on our article1 and appreciate having an opportunity to respond. First, Dr Pandey notes that hematoma size is an important predictor of death and prognosis, citing Christoforidis et al.2 The mortality rate in that study was 78% among those with symptomatic hemorrhagic transformation, similar to that of our cohort. However, their multivariable analysis did not examine whether hematoma volume independently predicted death; rather, they showed that a hematoma volume greater than 25 mL was an independent predictor of change in the National Institutes of Health Stroke Scale score among survivors. Much of the literature on ICH volume and outcome is based on patients with spontaneous ICH, and ICH volume is clearly one of the most important predictors of outcome in such patients. Our study examined patients with hemorrhagic transformation of an underlying ischemic stroke, and it may be that the size of the original infarct is as important as ICH volume. In fact, for patients with small hemorrhage volumes, infarct size may be an even more powerful predictor of outcome than ICH volume.

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