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Hyperacute extensive middle cerebral artery territory infarcts. Role of computed tomography in predicting outcome
Wynnie Wai-Man Lam1, Thomas Wai-Hong Leung, Winnie Chiu-Wing Chu
1Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, c/o Room 27029, Prince of Wales Hospital, Ngan Shing Street, Shatin, NT Hong Kong. wynnie@cuhk.edu.hk
Insights
Computed tomography (CT) features and admission National Institutes of Health Stroke Scale (NIHSS) scores predict survival in hyperacute middle cerebral artery (MCA) infarcts. Specific CT findings and NIHSS scores offer valuable prognostic information for patient outcomes.
Area of Science:
- Neurology
- Radiology
- Stroke Medicine
Background:
- Hyperacute stroke management requires accurate prognostication.
- Early identification of high-risk patients with middle cerebral artery (MCA) infarcts is crucial.
Purpose of the Study:
- To evaluate the prognostic capability of computed tomography (CT) findings in hyperacute MCA infarcts.
- To correlate CT features and National Institutes of Health Stroke Scale (NIHSS) scores with 30-day mortality.
Main Methods:
- Retrospective analysis of 16 patients with hyperacute MCA infarcts.
- Correlation of CT features (infarct extent, corticomedullary differentiation), total CT score, and admission NIHSS score with 30-day mortality.
Main Results:
- Admission NIHSS scores were significantly lower in survivors (P = 0.016).
- Infarct extent (>67%), attenuated corticomedullary differentiation, and higher CT scores (>4) were associated with 30-day mortality (P < 0.05).
- High predictive values were observed for infarct extent and corticomedullary differentiation in mortality prediction.
Conclusions:
- CT features and admission NIHSS scores are significant predictors of survival in hyperacute extensive MCA infarcts.
- These imaging and clinical markers aid in assessing prognosis and guiding patient management.
Objective:
To assess the prognostic value of computed tomography (CT) in hyperacute middle cerebral artery (MCA) infarcts.
Methods:
The CT features, total CT score, and National Institutes of Health Stroke Scale (NIHSS) score were correlated with the 30-day mortality in 16 patients with a hyperacute MCA infarct.
Results:
Admission NIHSS scores were significantly lower in the survival group (P = 0.016). The extent of infarct, attenuation of corticomedullary differentiation, and total CT score were associated with 30-day mortality (P < 0.05). In prediction of mortality, extent of an infarct > 67% gave sensitivity, specificity, positive predictive value, and negative predictive value rates of 86%, 100%, 100%, and 90%, respectively. Attenuation of corticomedullary differentiation gave sensitivity, specificity, positive predictive value, and negative predictive value rates of 86%, 89%, 86%, and 89%, respectively. An NIHSS score > 28 gave sensitivity, specificity, positive predictive value, and negative predictive value rates of 86%, 67%, 67%, and 86%, respectively. A CT score > 4 gave sensitivity, specificity, positive predictive value, and negative predictive value rates of 86%, 78%, 75%, and 88%, respectively.
Conclusions:
Computed tomography features and the admission NIHSS score are important predictors of survival in hyperacute extensive MCA infarcts.
