Hyperintense acute reperfusion marker on FLAIR is not associated with early haemorrhagic transformation in the elderly

Eur Radiol. 2010 Dec;20(12):2990-6. doi: 10.1007/s00330-010-1881-9. Epub 2010 Jul 21.


Objectives: The hyperintense acute reperfusion marker (HARM) has been described as a predictor for haemorrhagic transformation (HT) in acute ischaemic stroke. We hypothesised that this phenomenon is not present in the elderly.

Methods: It was possible to assess 47/84 consecutive patients aged 80 and over with diagnosed ischaemic stroke or transient ischaemic attack (TIA). MRI was performed within 24 h of onset of symptoms with follow-up MRI within a further 48 h.

Results: Of 47 included patients, 19 showed HARM; it was only seen on follow-up examination. Ten of the 47 patients underwent thrombolysis with recombinant tissue plasminogen activator (rt-PA); 4 of them showed HARM, and 1 of those showed HT. HARM was found in three out of eight patients with haemorrhagic transformation on baseline and/or follow-up MRI. We did not observe an association between HARM and early HT either in the whole group or in the patients who received thrombolysis.

Conclusion: HARM was not associated with HT in the elderly after ischaemic stroke, independent of treatment. While it may indicate dysfunction of the blood-brain barrier (BBB), it does not necessarily amount to HT.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged, 80 and over
  • Cerebral Hemorrhage / etiology*
  • Cerebral Hemorrhage / pathology*
  • Female
  • Humans
  • Ischemic Attack, Transient / complications*
  • Ischemic Attack, Transient / pathology*
  • Magnetic Resonance Imaging / methods*
  • Male
  • Reperfusion Injury / etiology*
  • Reperfusion Injury / pathology*
  • Reproducibility of Results
  • Sensitivity and Specificity