Inclusion and exclusion criteria
arteriovenous malformation, bleeding, Gastrointestinal or genitourinary bleeding, Stroke, stroke, Seizure, intracranial aneurism, brain abscess, liver and kidney failure)• Known, neoplasm, HT, rtPA, head trauma, allergic reactions, trauma
BLEEDING, STROKE, ACUTE MYOCARDIAL INFARCTION, INTRACRANIAL HEMORRHAGE, STROKE, INFECTIVE ENDOCARDITIS, BRAIN TUMOR, ALLERGIC REACTION, BRAIN ABSCESS, ISCHEMIC STROKE, DISORDERS, SUBARACHNOID HEMORRHAGE, PERICARDITIS, NEOPLASM, ACUTE PANCREATITIS, BLOOD, DUODENAL ULCER, BLEEDING DIATHESIS
Main inclusion and exclusion criteria are outlined in Table Inclusion and exclusion criteria
• Confirmed diagnosis of acute ischemic stroke• Age ≥ 18 years• Onset of stroke symptoms within 4.5 h before initiation of rtPA administration
• Current or previous intracranial hemorrhage• Symptoms suggestive of subarachnoid hemorrhage, even if CT scan was normal• Imaging data on admission suggestive of a brain tumor, arteriovenous malformation, brain abscess or intracerebral aneurism• Previous history of brain tumor, intracranial aneurism or arteriovenous malformation• Previous history of brain or spine surgery• Acute myocardial infarction within the previous 3 months• Major bleeding, current or within the previous 6 months• Gastrointestinal or genitourinary bleeding within the previous 3 months• Confirmed relapse of gastric or duodenal ulcer• Unknown time of symptom onset• Minor (NIHSS score < 4) or severe stroke (NIHSS score > 25) on admission• Seizure at stroke onset• Stroke or serious head trauma within the previous 3 months• Administration of heparin within the 48 h preceding the stroke onset, with an activated partial thromboplastin time at presentation exceeding the upper limit of the normal range• Platelet count < 100 × 10• Systolic blood pressure > 185 mm Hg or diastolic blood pressure > 110 mm Hg• Blood glucose < 50 mg/dL (2.8 mmol/L) or > 400 mg/dL (22.2 mmol/L)• Oral anticoagulant treatment• Major surgery or severe trauma within the previous 3 months• Other major disorders associated with an increased risk of bleeding (neoplasm, bleeding diathesis, acute pancreatitis, infective endocarditis, pericarditis, severe liver and kidney failure)• Known allergic reactions to rtPA, Cerebrolysin and its components• Pregnancy and lactation• Endovascular treatmentAll recruited patients admitted to the Interregional Clinical Diagnostic Center (Kazan, Russia) who met additional inclusion criteria were consecutively subjected to advanced brain imaging. The criteria were as following: no contraindications to magnetic resonance imaging (MRI) and computed tomography (CT) perfusion (CTP) study, AIS in the middle cerebral artery territory with a minimum diffusion-weighted imaging (DWI) lesion diameter of 20 mm on admission. Patients with any HT on a follow-up CT scan were excluded from the analysis due to paramagnetic distortions caused by blood on the diffusion-tensor imaging (DTI).The center was selected for advanced brain imaging because it was the only one with MRI being available 24/7.