Gunatilake reported two patients with intracerebral haemorrhage and resolution of symtoms and signs within 24 hours (1). Previously, Aparicio et al and Alvarez reported other two patients with similar clinical course( 2,3), one due to anticoagulant therapy (3),
On the other hand, Rey et al (4) reviewed all the clinical trials in which aspirin was used in the secondary and primary prevention of ischemic stroke and there was an increased risk associated with the use of aspirin as a compared to a placebo with respect to a intracerebral haemorrhage (Odd ratio= 2,08; IC 95%=1,32-3,29; p=0,0009).
In conclusion, it is felt that a cranial CT should be also mandatory before starting antiplatelet therapy and should be performed within 6 hours after the symptoms onset. Bogousslavsky et al (5) reported 15 patients with cerebral intra-infarct haematoma (type 2 of cerebral haemorragic infarct) in whom cranial CT showed no bleeding within 6 hours of stroke onset but showed intracerebral haemorrhage less than 18 hours later. The findings in the second cranial CT sugessted intracerebral haemorrhage in a review by two radiologist and two neurolgist whom were blinded to the first cranial CT. In these patients a primary infarct was suspected only because they had a cranial CT within 6 hours after the infarct onset.
1. Gunatilake SB. Rapid resolution of symtoms and signs of intracerebral haemorrhage: case reports.
2. Aparicio A, Sobrino J, Arboix A, Torres M. Hematoma intraparenquimatoso que simula un accidente isquémico transitorio. Med Clin ( Barc) 1995; 104: 478-479.
3. Alvarez J. Hematoma intraparenquimatoso que simula un accidente isquémico transitorio. Med Clin ( Barc) 1995; 105: 598.
4. Rey A, Martí-Vilalta. Enfermedad cerebrovascular yatrogénica. Rev Neurol 1995; 23(Supl 1): 131-146.
5. Bogousslavsky J, Regli F, Uské A, Maeder P. Early spontaneous hematoma in cerebral infarct: is primary cerebral hemorrhage overdiagnosed?. Neurology 1991; 41: 837-840
Competing interests: No competing interests