Ischaemic stroke with haemorrhagic transformation, also known as haemorrhagic infarct, occurs in approximately one-third of cases of ischaemic stroke. Haemorrhagic infarct occurs more commonly in the elderly, those with larger infarcts as well as those having received thrombolytic therapy. The mechanism of haemorrhagic infarct has been postulated to be due to the breakdown of the basal lamina of microvessels related to activity of matrix metalloproteinase. This may be a consequence of prolonged ischaemia and exacerbated by recanalization of the occluded artery. The use of thrombolytic agents may exacerbate this process. The series of non-contrast CT scans showed here (Figures 1 to 8) demonstrates haemorrhagic transformation of an underlying cerebral infarction involving the left middle cerebral artery territory . This patient presented with an acute onset of dense right sided weakness, expressive and receptive dysphasia. Tissue plasminogen activator was given as the patient presented within 3 hours of symptom onset and there were no contra-indications for the use of thrombolytic agents. The patient had mild residual right-sided weakness and expressive dysphasia upon discharge from a stroke rehabilitation hospital.
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