Clinical-radiographic correlations within the first five hours of cerebral infarction

Abstract

Fifty patients, ages 54-79, with ischemic hemispheric strokes productive of hemiparesis, at a minimum, underwent standardized neurological evaluations, computed tomographic scanning and cerebral angiography (N = 38) or carotid ultrasound (N = 12) within 5 h of onset. A second scan was performed at 5-7 days. Clinical scores were not associated with a history of, or the presence of: hypertension, smoking or cardiac disease, including atrial fibrillation, nor with severe internal carotid artery stenosis or occlusion. Clinical scores were adversely affected by early scan abnormalities (especially mass effect), lesion size, intracranial arterial occlusions, elevated serum glucose levels and the subsequent development of hemorrhagic infarction. Glucose levels correlated with infarct size and the development of hemorrhagic infarction. Delayed intracranial arterial filling and collateral flow were associated with reduced infarct size but did not confer clinical protection. We believe that combining the initial glucose level and scan results has prognostic significance, and early angiography is valuable in characterizing infarct etiology and assessing clinical severity.

Persistent Poststroke Hyperglycemia Is Independently Associated With Infarct Expansion and Worse Clinical Outcome

“…24,25 This is one of the few imaging studies examining the relationship between acute stroke and hyperglycemia. Using CT, Horowitz et al 41 previously found that admission glucose levels correlated with infarct size and hemorrhagic transformation. Analysis of a large cohort by Toni et al 42 initially indicated no association between admission glucose within 12 hours of hemispheric stroke and outcome CT lesion size.…”

Frequency and risk factors for spontaneous hemorrhagic transformation of cerebral infarction

“…Only 12 of the observational studies 11,13,14,17,18,[20][21][22]26,28,30,33,34,54 and 6 of the RCTs 38,40,44,46,51,53 defined what they meant by the radiologic appearances of HTI. Less than half of all studies included a radiologist among the authorship (Tables 1 and 2), thus, one could presume that the images were not reviewed by a dedicated and trained brain imager.…”

Frequency and Determinants for Hemorrhagic Transformation of Cerebral Infarction

“…Table 2 summarizes the methods and results of the main observational studies, conducted in series of patients with IS not treated with thrombolytic therapy. Different risk factors for HT have been identified: stroke severity [9,13] , older age [10] , the presence of early signs at the first CT scan [3,7,11,18] , the size of infarct area [3, 8-10, 12, 14] , cardioembolic stroke [9,14,17,18] and hyperglycemia/diabetes [13] .…”