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Brain scanning in cerebral vascular disease: a reappraisal
Insights
Abnormal brain scans are common in cerebral vascular disease patients, especially with thromboembolic infarction. Scan abnormalities correlate with poor neurological recovery and mortality, highlighting the importance of timely diagnosis.
Area of Science:
- Neurology
- Radiology
Background:
- Cerebral vascular disease, including stroke, significantly impacts patient outcomes.
- Brain imaging is crucial for diagnosing and managing stroke patients.
Purpose of the Study:
- To evaluate the frequency of abnormal brain scans in stroke intensive care unit patients.
- To correlate scan findings with diagnosis, symptom onset, imaging delays, and neurological recovery.
Main Methods:
- Retrospective analysis of brain scans in patients admitted to a stroke intensive care unit.
- Evaluation of scan results based on diagnosis (thromboembolic infarction, hemorrhagic infarction, transient ischemic attacks/reversible ischemic neurological deficit).
- Assessment of imaging timing, delayed views, and correlation with clinical outcomes.
Main Results:
- 33% of patients with completed thromboembolic infarction had abnormal scans, with higher rates for hemispheric (39%) versus posterior fossa (14%) lesions.
- 43% of patients with completed hemorrhagic infarction showed abnormal scans.
- 14% of patients with transient ischemic attacks or reversible ischemic neurological deficit had abnormal scans.
- Abnormal scans were detected in 27% within two days of thromboembolic infarction, a higher frequency than previously reported.
- Delayed imaging identified abnormalities in 10% of cases where initial scans were normal.
- Abnormal scan frequency was significantly higher in patients with poor neurological recovery or mortality.
Conclusions:
- Brain imaging is highly valuable in identifying abnormalities in acute stroke patients.
- Early detection of scan abnormalities, even with delayed imaging, is associated with poorer clinical outcomes.
- These findings underscore the prognostic significance of brain imaging in cerebral vascular disease management.
Abstract:
The frequency of abnormal brain scans in patients with cerebral vascular disease admitted to a stroke intensive care unit has been evaluated in relation to diagnosis, time after onset of symptoms, effect of delayed imaging and the degree of clinical neurological recovery. In patients with completed thromboembolic infarction, 33% had abnormal scans including 39% of those with hemispheric lesions and 14% with posterior fossa lesions. Completed hemorrhagic infarction occurred in seven patients, and three (43%) had abnormal brain scans. Of 14 patients with either transient ischemic attacks or reversible ischemic neurological deficit, two (14%) had abnormal scans. Twenty-seven percent of brain scans in patients with completed thromboembolic infarction were abnormal in the first two days after infarction, a higher frequency than previously reported. Delayed images confirmed the initial interpretation that the scan was either normal or abnormal in 71% of the cases while in 10% of the cases only the delayed views were abnormal. The frequency of abnormal scans was significantly greater in patients who died or had a large neurological deficit at discharge than in patients with lesser residual deficit.