Do early ischemic changes on computed tomography predict the stroke severity and functional outcome in patients with acute ischemic stroke?

ABSTRACT

Computed Tomography [CT] is available in all stroke centers and can be interpreted by all radiologists and even by trained neurologists. The study aim was to test the association of early ischemic changes [EICs] on initial CT with different variables especially the stroke severity and the functional outcome. Retrospective analysis of 118 patients [aged 70.2 +/- 11.9 years [mean +/- SD]; 45% females] with middle cerebral artery [MCA]-stroke treated with intravenous recombinant tissue plasminogen activator [rtPA] at the neurology department of our university hospital May 2004-May 2008. Out of 118 patients, 52 [44.1%] showed EICs. Of 52 with EICs 50 [96%] developed MCA infarction [P<0.001], 11 [21%] had altered consciousness [P=0.032], and 20 [38%] were institutionalized three months after stroke [P=0.024]. Similarly patients with EICs sustained larger infarcts [infarct volume 79 cm[3]] than patients with no EIC [infarct volume 22 cm[3]]; P<0.001. The total time between the stroke onset and initiation of thrombolysis therapy was shorter in patients with EICs than in those with no EICs [109 vs. 124 minutes]; P=0.016 Excluding the hyperdense middle cerebral artery sign [HMCAS], the difference in the functional outcome in patients with other EICs was not statistically significant compared with that in patients with no EICs [P=0.214]. However, patients with EICs other than HMCAS showed to have more severe stroke [mean NIHSS on admission 14.5] than those with no EICs [mean NIHSS on admission 11.5], P=0.036. The difference between the NIHSS at 24 hours' control was also statistically significant when comparing the two groups [11.3 in patients with EICs vs. 6.8 in patients with no EICs], P=0.025. EIC showed to be associated with severe stroke and poor functional outcome. Excluding HMCAS, other EICs are only associated with development of sever stroke