BackgroundAccording to current guidelines, stroke patients treated with rt-PA should undergo brain imaging to exclude intracerebral bleeding 24 hours after thrombolysis, before the start of medical secondary prevention. However, the usefulness of routine follow-up imaging with regard to changes in therapeutic management in patients without neurological deterioration is unclear.We hypothesized that follow up brain imaging solely to exclude bleeding in patients who clinically improved after rt-PA application may not be necessary.MethodsRetrospective single-center analysis including stroke patients treated with rt-PA in 2015 at the Department of Neurology, Charitu00e9 - Universitu00e4tsmedizin Berlin, Germany. Medical records were reviewed for hemorrhagic transformation one day after systemic thrombolysis and brain imaging-based changes in therapeutic management. Twenty-four hours after thrombolysis patients were divided into four groups: 1) increased NIHSS score; 2) unchanged NIHSS score; 3) improved NIHSS score and; 4) NIHSS score =0 compared to baseline. ResultsOut of 188 patients (mean age 73 years, 100 female) receiving rt-PA, 32 (17%) had imaging-proven hemorrhagic transformation including 11 (6%) patients with parenchymal hemorrhage. Patients in group 1) and 2) more often had hypertension (p=0.015) and more often had parenchymal hemorrhage (9% vs. 4%; p

BackgroundIntracerebral hemorrhage (ICH) is the second most common cause of stroke. Early ICH imaging and diagnostics (e.g., blood pressure, coagulation status) is prognostically crucial. However, only limited data is available on ultra-early hemorrhage growth within the first 60 minutes after symptom onset (u201cgolden houru201d).MethodsWe prospectively collected data on ICH imaging using two registries, the Berlin Mobile Stroke Unit (MSU) registry and B-SPATIAL (clinicaltrials.gov, NCT03027453). We identified 60 patients receiving golden hour imaging: 35 patients with prehospital CT scan aboard the MSU (43.2% of 81 patients), and 25 patients with CT or MR imaging at hospital arrival after EMS transport (14.4% of 174 patients). Hemorrhages were measured using ABC/2 formula.ResultsUnivariate comparison of MSU versus EMS group are shown in Table 1. A logistic regression analysis of functional outcome adjusted for GCS severity revealed no significant difference between both groups. ConclusionWe could show that MSU intervention compared to usual EMS transport, especially in the very early period after ICH, did not raise any safety concerns. Prospective prehospital studies investigating the ultra-early hematoma growth will be carried out using repetitive imaging.