الفهرس 
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Abstract
Introduction: Hemorrhagic transformation (HT) is one of the most common and serious challenges in management of acute ischemic stroke (AIS) that affects both the treatment plan and the clinical prognosis. It is still one of the most feared complications of thrombolysis that restricts its indications. The identification of risk factors for HT might be helpful in improving the risk-benefit ratio of thrombolytic therapy. Aim: to detect the predictive factors associated with hemorrhagic transformation in patients with first ever AIS receiving rTPA for better preselection of patients eligible for thrombolytic therapy to prevent such complication. Subjects and methods: The study was carried out at the Department of Neuropsychiatry and Center of Psychiatry, Neurology and Neurosurgery, Tanta University Hospitals. The duration of this study was 12 months starting from June 2021 to May 2022. The total number of patients included was 460 patients with AIS, 115 patients received rTPA and 345 patients did not receive rTPA. All patients were subjected to history taking, clinical examination and neurological examination including Glasgow Coma Score (GCS), National Institute of Health Stroke Scale (NIHSS) and radiological investigation as well as cardiac investigation. The patients were followed up for two weeks clinically by NIHSS Score and radiologically by CT or MRI brain to detect hemorrhagic transformation. Results: patients with HT represented 21.7% of all patients receiving rTPA while sICH represented (6.9%). rTPA patients of HT had significant higher blood pressure (BP), respiratory rate, atrial fibrillation (AF) rate, NIHSS score, INR, prothrombin time, neutrophil-lymphocyte ratio (NLR), lower platelet count, LDL level and ASPECT score (p value< 0.005). Conclusion: Hemorrhagic transformation represents one of the main complications of acute ischemic stroke patients undergoing or not urgent revascularization, and, especially when symptomatic, is associated with neurological deterioration and worse prognosis, with higher mortality and residual disability. Prediction of HT is therefor of the main importance in clinical practice to optimize its management and possibly improve outcome. In our study six predictors were associated with HT (higher respiratory rate, atrial fibrillation, higher NL ratio, lower LDL, lower ASPECT score and door to needle time > 180 minutes).