Fever is common in critically ill neurosurgical patients, especially those with a prolonged length of stay in the ICU or a cranial disease. If hyperthermia worsens the functional outcome after a primary ischemic or traumatic injury, as has been suggested by several studies of stroke patients, treatment of fever is a clinical issue that requires better management.
Background and Purpose-Only a small percentage of acute-stroke patients receive thrombolytic therapy because of time constraints and the risks associated with thrombolytic therapy. We sought to determine whether xenon-enhanced CT (XeCT) cerebral blood flow (CBF) and/or CT angiography (CTA) in conjunction with CT can distinguish subgroups of acute ischemic stroke victims and thereby better predict the subgroups most likely to benefit and not to benefit from thrombolytic therapy. Methods-An analysis of 51 patients who had a CT, CTA, and stable XeCT CBF examination within 24 hours of stroke symptom onset was conducted. These initial radiographic studies and National Institutes of Health Stroke Scale score on admission were assessed to determine whether they could predict new infarction on follow-up CT or discharge disposition by use of the Fisher exact test to determine statistical significance. Results-Patients with no infarction on initial CT and normal XeCT CBF had significantly fewer new infarctions and were discharged home more often than those with compromised CBF. The same held true for patients with an open internal carotid artery and middle cerebral artery by CTA and normal CT compared with those with an occluded internal carotid artery and/or middle cerebral artery by CTA. Either was superior to CT and the National Institutes of Health Stroke Scale in prediction of outcome. Both enable the selection of a group of patients not identifiable by CT alone that would do well without being exposed to the risks of thrombolytic therapy. This study included too few patients to statistically assess the role of combining CTA and XeCT CBF information. Conclusions-The combination of CT, CTA, and Xe/CT CBF does define potentially significant subgroups of patients.The utility of this classification is supported by the observation that CTA and XeCT CBF are superior to CT alone in predicting infarction on follow-up CT and clinical outcome. This information may be useful in selecting patients for acute-stroke treatment.
P50 Background and Purpose: To compare the sensitivity and specificity of quantitative cerebral blood flow (qCBF) vs. time from symptom onset to the measurement of qCBF (Time) as a predictor of cerebral infarction in patients (pts.) with acute ischemic stroke. Methods: 51 pts. with acute ischemic stroke who were assessed with XeCT, CTA and CT within 24 hours of symptom onset were studied. The MCA territory was divided into anterior and posterior divisions (two divisions/pt. for a total of 102 divisions). The average qCBF for each of these divisions was calculated and initial and follow-up CT scans were read for new infarction in both divisions. 24 divisions with evidence of prior infarction on the initial CT were excluded from the analysis. This left a total of 78 divisions available for analysis. Logistic regression was used to generate receiver operating curves (ROC) for both qCBF and Time. The area under each ROC curve is reported. Results: Twenty-one of the 78 (26.9%) divisions without initial infarction on CT had evidence of new infarction on the follow-up CT. The area under the qCBF curve was 0.81 compared with an area of 0.49 under the Time curve (p=0.00025). Excluding patients receiving thrombolytic therapy, (n=11), the area under the qCBF curve was 0.799 and the area under the Time curve was 0.590 (p=0.00004). The area under the ROC curve for qCBF was significantly greater than Time in those patients studied < 180 minutes (qCBF=0.92, Time=0.51; p=0.02) and > 180 min. (qCBF=0.76, Time=0.50; p=0.01) Conclusion: Quantitative cerebral blood flow measured by XeCT is a better predictor of new infarction on follow-up CT than Time in pts. with acute ischemic stroke. This holds true for time < 180 minutes and > 180 minutes.
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