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The correlation of CT findings and in-hospital mortality after cerebral infarction
1Department of Neurology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Brasil.
Insights
Computed tomography (CT) scans can predict early mortality in acute cerebral infarction patients. Key indicators include herniation, midline shift, and large infarct size, suggesting CT
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Acute cerebral infarction, or ischemic stroke, poses a significant risk of early mortality.
- Predicting mortality is crucial for patient management and resource allocation.
Purpose of the Study:
- To determine the predictive value of computed tomography (CT) findings for early mortality following acute cerebral infarction.
Main Methods:
- Admission CT scans were analyzed in 98 acute cerebral infarction patients.
- CT findings were assessed using a checklist and correlated with hospital mortality via logistic regression.
Main Results:
- Uncal herniation and midline shift > 4 mm strongly predicted fatal outcomes.
- Large infarct volume, hemispheric infarction, and significant mass effect were associated with increased mortality.
- Lesion extension in middle cerebral artery territory also correlated with worse outcomes.
Conclusions:
- CT findings indicative of substantial mass effect and large infarcts are linked to mortality in ischemic stroke.
- Further research is needed to combine CT and clinical variables for precise individual risk assessment.
Objective:
To evaluate whether findings on computed tomography (CT) are useful to predict early mortality after acute cerebral infarction.
Methods:
An admission CT was performed in 98 patients with disease-onset within 7 days; CT findings were analyzed using a checking list; their influence on hospital mortality was studied by logistic regression analysis.
Results:
There were 29 hospital deaths. Uncal herniation and midline shift > 4 mm were strongly correlated with fatal outcome. Also associated with increased mortality: infarction of a whole hemisphere or in the distribution of internal carotid artery; massive (> 90% expected area) infarction in the territory of the anterior or posterior cerebral arteries; massive or submassive (> 50% expected area) middle cerebral artery infarction; large lesion volume (death in 9/13 patients with lesions > 50cm3); any degree of mass effect. In 68 patients with single middle cerebral artery lesions, extension of the lesion to adjacent vascular territories was also associated with a worse outcome. The number of lesions and the presence of contrast enhancement, hemorrhagic changes or cerebral atrophy did not influence outcome.
Conclusions:
CT findings indicating significant mass effect and large infarcts are associated with mortality after ischemic stroke. The best combination of clinical and CT variables to estimate death risk in individual patients remains to be determined.
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