Sequential computed tomography scans in acute cerebral infarction.

Abstract

Sequential computed tomography (CT) scans were obtained in 30 patients with acute cerebral infarction. In some cases, infarction was seen on the scans as early as three to six hours after onset of symptoms. Although small areas of petechial hemorrhagic infarction are not easily detected by currently available equipment, positive contrast enhancement helps locate petechial hemorrhagic infarction, which is usually in the cortical gray matter of the cerebral mantle and the central gray matter of the deep central gray matter. Contrast-enhanced CT scans are a useful method for detecting small infarctions. However, when a CT scan is performed within five days of ictus, contrast enhancement is usually not required.

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.…”

The clinical spectrum of hemorrhagic infarction.

“…21 Isolated petechial hemorrhages may be too small to distinguish from surrounding tissue. 2223 Contrast enhancement has been advocated to demonstrate small areas of petechial hemorrhage in a region of gray matter infarction, 24 or to predict patients at risk for developing HI. 23 In our experience, contrast scans were done too infrequently to draw any conclusions about their usefulness in this situation.…”

Sonographic Monitoring of Midline Shift in Space-Occupying Stroke

“…[5][6][7][8] Lateral displacement of midline structures resulting from progressive postischemic edema has been found to correlate closely with a poorer outcome in stroke patients. 5,7,9,[10][11][12][13][14] In a subgroup of stroke patients with rapid progressive edema, the mortality rate reaches 80% as the result of axial brain stem herniation. 15,16 Several open, prospective studies indicate that decompressive hemicraniectomy can decrease mortality rates up to 50% in so-called "malignant" middle cerebral artery (MCA) stroke, that is, postischemic edema unresponsive to treatment.…”