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The diagnosis and management of cerebral embolism and haemorrhagic infarction with sequential computerized cranial tomography.

Haemorrhagic infarction is typically not present immediately after cerebral embolism. Spontaneous haemorrhagic transformation evolves over several days. As a consequence, delayed CT scans are essential to exclude haemorrhagic infarction before initiating anticoagulant therapy. Sequential CT scanning can also help in the diagnosis of cerebral embolism in patients with stroke of unknown cause. In such cases the detection of haemorrhagic infarction on a delayed scan suggest an embolic mechanism. The evolution of haemorrhagic infarction on sequential CT scans graphically demonstrates the dynamic nature of this lesion and thereby indicates why serious brain haemorrhage may result from anticoagulation immediately after cerebral embolism.