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Correlation of Neurologic Dysfunction with CT Findings in Early Acute Stroke

Published online by Cambridge University Press:  02 December 2014

J.N. Scott ,
A.M. Buchan  and
R.J. Sevick
J.N. Scott
Affiliation:
Department of Diagnostic Imaging, Foothills Hospital, University of Calgary and the Alberta Stroke Program, Calgary, Alberta, Canada
A.M. Buchan
Affiliation:
Department of Clinical Neurosciences, Foothills Hospital, University of Calgary and the Alberta Stroke Program, Calgary, Alberta, Canada
R.J. Sevick
Affiliation:
Department of Diagnostic Imaging, Foothills Hospital, University of Calgary and the Alberta Stroke Program, Calgary, Alberta, Canada Department of Clinical Neurosciences, Foothills Hospital, University of Calgary and the Alberta Stroke Program, Calgary, Alberta, Canada Department of Anatomy, Foothills Hospital, University of Calgary and the Alberta Stroke Program, Calgary, Alberta, Canada
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Abstract

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Objective:

To determine the frequency of early computed tomographic (CT) findings of ischemia and their relationship to symptom duration and neurologic dysfunction within 3 hours of ischemic stroke.

Methods:

The CT scans of 39 acute stroke patients were evaluated for signs of early ischemic change within 3 hours of symptom onset and without knowledge of the patient’s neurologic deficit or results of a 24 hour follow-up post-thrombolysis CT. Early CT signs of acute ischemic change or thromboembolism were hypoattenuation of the insular ribbon, obscuration of the lentiform nucleus, cortical hypodensity/effacement, and hyperdense middle cerebral artery sign.

Results:

Signs of acute ischemic change were seen on the baseline scan in 25/39 patients (64%). Hypoattenuation of the insular ribbon was seen in 11 patients, obscuration of the lentiform nucleus in 13, cortical hypodensity/effacement in 13, and hyperdense middle cerebral artery sign in 7. The prevalence of early ischemic signs was directly associated with increasing neurologic disability at the time of presentation. No clear relationship existed between symptom duration and the presence of CT signs.

Conclusion:

Evidence of cerebral ischemia is frequently seen on CT within 3 hours of symptom onset. The degree of neurologic disability correlates with CT signs of ischemia.

Résumé

RÉSUMÉ<span class='bold'><span class='italic'>Objectif:</span></span>

Il s’agit de déterminer la fréquence de manifestations précoces d’is- chémie à la tomographie assistée par ordinateur (CT) et leur relation avec la durée de la symptomatologie et avec la dysfonction neurologique, en dedans de trois heures d’un accident vasculaire cérébral ischémique (AVCI).

<span class='italic'><span class='bold'>Méthodes:</span></span>

Nous avons examiné le CT scan de 39 patients présentant un AVCI pour détecter des signes précoces de changements ischémiques en dedans de 3 heures du début des symptômes et sans connaître le déficit neurologique du patient ou les résultats du CT fait 24 heures après la thrombolyse. Les signes précoces de changements ischémiques aigus au CT ou de thrombo-embolie étaient une hypoatténuation du ruban insulaire, une obscuration du noyau lenticulaire, une hypo- densité/un effacement cortical et le signe de l’artère cérébrale moyenne hyperdense.

<span class='italic'><span class='bold'>Résultats:</span></span>

Des signes de change- ments ischémiques aigus ont été observés au scan initial chez 25 patients sur 39 (64%). Une hypoatténuation du ruban insulaire a été observée chez 11 patients, une obscuration du noyau lenticulaire chez 13, une hypodentité/un efface- ment cortical chez 13 et le signe de l’artère cérébrale moyenne hyperdense chez 7. La prévalence de signes ischémiques précoces était directement associée à un déficit neurologique progressif au moment où le patient a con- sulté. Il n’existait pas de relation claire entre la durée des symptômes et la présence de signes au CT scan.

<span class='italic'><span class='bold'>Conclusions:</span></span>

Des manifestations d’ischémie cérébrale sont observées fréquemment au CT scan en dedans de 3 heures du début des symptômes. Le degré de dysfonction neurologique est en corrélation avec les signes d’ischémie observés au CT scan.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 26 , Issue 3 , November 1999 , pp. 182 - 189
Copyright
Copyright © The Canadian Journal of Neurological 1999

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