Computed tomographic-angiographic findings within the first five hours of cerebral infarction.

Abstract

Background and Purpose: Modern management of acute stroke necessitates early diagnosis. To this end, we sought to delineate the radiographic features of focal hemispheric infarction within 5 hours of ictus.Methods: Fifty patients, ages 54-79, with ischemic strokes productive of at least hemiparesis underwent computed tomographic scanning and cerebral angiography (n=38) or carotid ultrasound (n=12). Radiographic lesions were characterized for location, size, and pathophysiology.Results: Acute abnormalities, hypodensity, and mass effect were seen in 56% of scans and confirmed on a second scan 5-7 days later. Intracranial angiographic abnormalities occurred in 61% of patients: arterial occlusions in 45% and delayed arterial filling in 16%. Hemorrhagic infarctions occurred in 26% of second scans and were associated with mass effect (100%) and arterial occlusions (89%). Infarcts with hemorrhagic transformation were larger on both scans than those without (p=0.001). Of four patients with infarctions in watershed territories on the scans, two had middle cerebral artery occlusions on angiography, thereby questioning the specificity of such scan lesions to low-flow states.Conclusions: We conclude that cerebral infarctions are often visible on early scans, but their locations may not be etiologically determinative. The infarcts associated with intracranial arterial occlusions (45%) were of thromboembolic origin, but, given current controversies as to the pathophysiology of lacunar and watershed infarctions, we cannot ascertain the etiology in the remainder. These findings are relevant to the new stroke therapies that require administration in the first hours after infarction. (Stroke 1991^2:1245-1253)

Attenuated Corticomedullary Contrast: An Early Cerebral Computed Tomography Sign Indicating Malignant Middle Cerebral Artery Infarction

“…8 The identification of very early changes on CCT scans in acute ischemic stroke patients has been the subject of previous studies stressing even subtle parenchymal alterations only hours after stroke onset in the majority of patients. [11][12][13][14][15][16][17][18][19] In a recent series of patients with MCA territory infarctions, the incidence of positive findings was 68% in CCT scans performed within 2 hours of stroke onset, increasing to 89% within 3 hours. 19 These data emphasize the great value of emergency CCT scanning in acute stroke management, which is superior to MRI in this patient population.…”

“…In part, they have been used in previous studies of early CCT changes in acute ischemic stroke. [7][8][9][11][12][13][14][15][16][17][18][19] In accordance with the clinical experience of the authors that early loss of CMC has been associated with poor outcome in ischemic and traumatic brain injuries, this CCT criterion was additionally introduced.…”

Prognostic factors in first-ever stroke in the carotid artery territory seen within 6 hours after onset.

“…19 Atrial fibrillation, myocardial infarction, rheumatic heart disease, and dilated cardiomyopathy were also analyzed, pooled under the single category of "potential cardioembohc sources. "…”

Neuroprotection in acute ischaemic stroke. II: Clinical potential

“…Angiography performed in patients with ischaemic stroke within a few hours of the onset of symptoms shows thrombo-embolic arterial occlusion in many (though by no means all) cases, 71 and attempts to unblock these arteries by giving thrombolytic agents have been made for over 30 years. 72,73 Streptokinase (SK), urokinase (UK) and alteplase (rt-PA) 74,75 have all been given intravenously or intraarterially, though before the era of CT scanning the risks of severe intracerebral haemorrhage were unacceptable.…”