Risk factors for Deep & Lobar/ CTDR

Remote parenchymal hemorrhage (rPH) after intravenous thrombolysis is defined as hemorrhages that appear in brain regions without visible ischemic damage, remote from the area of ischemia causing the initial stroke.  934  (mean age 73.9±12.6 years). We observed rPH in 34  (3.6%); 9 (0.9%) were deep and 25 (2.7%) lobar. No hemorrhage was observed in 900 (96.6%). High blood pressure within the first 24 hours after intravenous thrombolysis is associated with deep rPH, whereas lobar rPH are associated with imaging markers of amyloid deposition. A positron emission tomography study found an association between those with CAA and IV-rtPA associated ICH.  With an acute ischemic stroke, speculate that deep rPH is the result of two concomitant processes (hypertensive episodes and IV-rtPA). Similarly, those with hypertension who are under treatment with anticoagulants have a high risk of a spontaneous deep ICH.