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Early CT changes and outcome of ischemic stroke
B D Aronovich1, I I Reider-Groswasser, Y Segev
1Stroke Unit, Department of Neurology, Tel Aviv Sourasky Medical Center and The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
European Journal of Neurology
|December 25, 2003
Summary
Early computed tomography (CT) scan signs in acute ischemic stroke patients did not predict outcomes. This finding challenges the hypothesis that early CT changes indicate risk for hemorrhage or poor prognosis, impacting treatment selection.
Area of Science:
- Neurology
- Radiology
- Emergency Medicine
Background:
- Recombinant tissue plasminogen activator (rt-PA) use in acute stroke care is debated, particularly regarding patient selection criteria.
- Early computed tomography (CT) findings in ischemic stroke are hypothesized to predict symptomatic intracerebral hemorrhage and poor outcomes.
Purpose of the Study:
- To investigate whether early CT scan changes in acute ischemic stroke (IS) patients predict clinical outcomes.
- To assess the predictive value of specific early CT findings for patient prognosis after acute IS.
Main Methods:
- Prospective outcome study of 150 acute ischemic stroke patients admitted within 6 hours of symptom onset.
- Neuroradiologists, blinded to clinical outcomes, evaluated CT scans for early ischemic changes (e.g., hypodensity, sulcal effacement, MCA hyperdensity).
- Patient outcomes were assessed at 30-day follow-up (discharge disposition, mortality).
Main Results:
- Early CT changes observed included tissue hypodensity (55.7%), effacement of sulci (41.3%), and MCA hyperdensity (13.3%).
- 30-day outcomes: 44% discharged home, 20% to rehab, 22% to chronic care, 14% died.
- Statistical analysis indicated that early CT signs did not reliably predict patient outcomes.
Conclusions:
- Early computed tomography findings in acute ischemic stroke patients do not appear to be reliable predictors of clinical outcome or prognosis.
- The hypothesis that early CT changes predict symptomatic hemorrhage or poor outcomes was not supported by this study's data.
- Further research may be needed to identify robust criteria for selecting patients for treatments like rt-PA.