Hakan AY, Erdem KARABULUT, Okay SARIBAŞ, F. İrsel TEZER, Adeviye GÖKOĞLU, Murat ARSAVA

İskemik inme sonrası kumadine bağlı oluşabilecek intrakraniyal kanama riskinin manyetik rezonans görüntüleme ile takibi

Amaç: Oral antikoagülan (OaK) ile tedavi edilenlerde, intraserebral kanama gelişme ihtimali, özellikle iskemik inme sonrası, benzer risk faktörleri olanlara göre 8-11 kat artmıştır. Kraniyal manyetik rezonans görüntülemede (MRG) gradiyent eko (GE) kesitlerle mikrokanamaların gösterilmesi, bu risk altında olan popülasyonun tanımlanabileceğini düşündürtmektedir. Bu çalışmada koruyucu inme tedavisiyle mikrokanamaların şiddeti arasındaki ilişkinin ortaya konulması amaçlanmıştır. Hasta ve Yöntem: Antikoagülan veya antiagregan tedavi alan 37 iskemik inmeli hastanın altı ay arayla çekilen GE-MRG ’lerinde, küçük kanama odaklarının sayısındaki değişim izlenmiştir. Bunla ilişkili olabilecek klinik ve MRG özelliklerinin belirlenmesi hedefl enmiştir. Ayrıca altıncı ay kontrol MRG ’si çekilemeyen 26 hastanın ilk MRG ’leri, birinci grubun ilk MRG ’leriyle birlikte değerlendirilmiştir. Bulgular: İlk MRG’leri değerlendirilen 63 hastanın %60 ’ında mikrokanama saptanmıştır. Yaşın artmasıyla mikrokanama sayısının arttığı gözlenmiştir. Mikrokanama insidansının ve sayısının, laküner enfarkt ve orta ve ağır derecede lökoariozisle de ilişkili olduğu tespit edilmiştir. Altı ay sonra MRG’si tekrarlanan 37 hastanın 14 ’ünde, mikrokanamalarda artış gözlenmiştir. Bunun tedavi gruplarında farklı olmadığı; yaşın, lökoariozis derecesinin, lakün sayısının ve diğer inme risk faktörlerinin etkili olmadığı istatistiksel olarak gösterilmiştir. Sonuç: Bu çalışma ileri yaşta, MRG ’de lökoariozis ve laküner enfarktı olan hastalarda, mikrokanama odakları bulunma olasılığının yüksek olduğunu göstermiştir. GE-MRG bu aşamada iskemik inmeli hastaların intraserebral kanama geliştirme riskinin ortaya konmasında önemli bir rol oynayabilir.

Risk assessment of coumadin-related intracranial hemorrhage via magnetic resonance imaging in patients with ischemic stroke

Introduction: The risk of intracerebral hemorrhage is increased to 8-11 fold, especially in patients with ischemic stroke. Gradient echo magnetic resonane imaging (GE-MRI) is able to show microhemorrhages. In that study, relationship between the frequency of microhemorrhage foci and treatment was investigated. Method: The changes of microhemorrhages in patients having anticoagulant or antiaggregant drugs due to ischemic stroke were followed with GE-MRI in six moths interval. The clinical and MRI fi ndings were also revealed. The fi rst and second MRIs of 37 patients were compared. The fi rst MRI fi ndings of these patients and 26 patients who had no sixth month MRI were evaluated as fi rst MRIs. Results: Micohemorrhages were documented in the 60% of 63 patients in the fi rst MRIs. The frequency was found to be increased with age, presence of lacuner infarction and moderate to severe leukoariosis. An increase of microhemorrhages was seen in the 14 of 37 patients in the six month follow-up, but there were no statistically signifi cant impact of treatment, MRI fi ndings and other risk factors. CONCLUSION: The study pointed out the GE-MRI seems to be a pivotal role in the assessment of the risk of intracranial hemorrhage in patients with ischemic stroke especially with advanced age, leukoariosis and lacuner infarction.

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