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BACKGROUND AND PURPOSE: Cerebral edema (CED) is a severe complication of acute ischemic stroke. There is uncertainty regarding the predictors for the development of CED after cerebral infarction. We aimed to determine which baseline clinical and radiological parameters predict development of CED in patients treated with intravenous thrombolysis. METHODS: We used an image-based classification of CED with 3 degrees of severity (less severe CED 1 and most severe CED 3) on postintravenous thrombolysis imaging scans. We extracted data from 42 187 patients recorded in the SITS International Register (Safe Implementation of Treatments in Stroke) during 2002 to 2011. We did univariate comparisons of baseline data between patients with or without CED. We used backward logistic regression to select a set of predictors for each CED severity. RESULTS: CED was detected in 9579/42 187 patients (22.7%: 12.5% CED 1, 4.9% CED 2, 5.3% CED 3). In patients with CED versus no CED, the baseline National Institutes of Health Stroke Scale score was higher (17 versus 10; P<0.001), signs of acute infarct was more common (27.9% versus 19.2%; P<0.001), hyperdense artery sign was more common (37.6% versus 14.6%; P<0.001), and blood glucose was higher (6.8 versus 6.4 mmol/L; P<0.001). Baseline National Institutes of Health Stroke Scale, hyperdense artery sign, blood glucose, impaired consciousness, and signs of acute infarct on imaging were independent predictors for all edema types. CONCLUSIONS: The most important baseline predictors for early CED are National Institutes of Health Stroke Scale, hyperdense artery sign, higher blood glucose, decreased level of consciousness, and signs of infarct at baseline. The findings can be used to improve selection and monitoring of patients for drug or surgical treatment.

Original publication




Journal article



Publication Date





2464 - 2471


cerebral edema, cerebral infarct, intracerebral hemorrhage, outcome, thrombolysis, Administration, Intravenous, Aged, Atrial Fibrillation, Brain Edema, Brain Ischemia, Cerebral Hemorrhage, Cerebral Infarction, Diabetes Mellitus, Female, Fibrinolytic Agents, Heart Failure, Humans, Hypertension, Logistic Models, Magnetic Resonance Imaging, Male, Middle Aged, Multivariate Analysis, Registries, Retrospective Studies, Risk Factors, Severity of Illness Index, Sex Factors, Stroke, Thrombolytic Therapy, Tomography, X-Ray Computed