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Disappearing hyperdense middle cerebral artery sign is associated with striatocapsular infarcts on follow-up CT in ischemic stroke patients treated with intravenous thrombolysis.
MedLine Citation:
PMID:  20664262     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: A striatocapsular infarct (SCI) is a subcortical infarct in the territory of the lenticulostriate arteries, most likely due to transient occlusion of the main stem of the middle cerebral artery (MCA). Presence of the hyperdense middle cerebral artery sign (HMCAS) is a reliable marker of occlusion of the MCA. We hypothesized that SCIs are related to HMCAS at baseline, which subsequently disappears (HMCAS-D) on follow-up CT in stroke patients treated with intravenous rtPA.
METHODS: Baseline and 24-hour follow-up CTs were evaluated for HMCAS in acute ischemic stroke patients treated with intravenous rtPA and follow-up scans were also reviewed for the presence of isolated cortical (CIn), SCI, cortical and striatocapsular (CI-SCI) or lacunar infarct. We determined the incidence of SCI and the association between SCI and HMCAS on baseline and follow-up CT.
RESULTS: Of the 247 patients, 43 had an SCI (17.4%; 95% CI: 13.1-22.5). The presence of HMCAS at baseline was related to the occurrence of infarction with involvement of the striatocapsular region (SCI or CI-SCI) on follow-up CT (OR: 11.6; 95% CI: 5.9-22.8). HMCAS-D on follow-up scans was significantly related to SCI on follow-up CT compared to CI-SCI (OR: 4.9; 95% CI: 3.7-6.1).
CONCLUSIONS: Occurrence of SCI and CI-SCI is associated with the presence of HMCAS on CT before thrombolysis, whereas HMCAS-D on follow-up CT is strongly related to the occurrence of SCI. Our findings support the causative role of transient occlusion of the MCA main stem in the pathogenesis of SCI.
Authors:
E C van Overbeek; I L H Knottnerus; R J van Oostenbrugge
Publication Detail:
Type:  Journal Article     Date:  2010-07-23
Journal Detail:
Title:  Cerebrovascular diseases (Basel, Switzerland)     Volume:  30     ISSN:  1421-9786     ISO Abbreviation:  Cerebrovasc. Dis.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-08-09     Completed Date:  2010-12-16     Revised Date:  2011-01-18    
Medline Journal Info:
Nlm Unique ID:  9100851     Medline TA:  Cerebrovasc Dis     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  285-9     Citation Subset:  IM    
Copyright Information:
Copyright 2010 S. Karger AG, Basel.
Affiliation:
Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands. e.overbeek@mumc.nl
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Cerebral Infarction / etiology,  physiopathology,  radiography*
Female
Follow-Up Studies
Humans
Injections, Intravenous
Male
Middle Aged
Middle Cerebral Artery / drug effects,  physiopathology,  radiography*
Retrospective Studies
Stroke / drug therapy*,  physiopathology
Thrombolytic Therapy / methods*
Tissue Plasminogen Activator / administration & dosage,  pharmacology,  therapeutic use*
Tomography, X-Ray Computed
Chemical
Reg. No./Substance:
EC 3.4.21.68/Tissue Plasminogen Activator
Comments/Corrections
Comment In:
Cerebrovasc Dis. 2011;31(2):207-8; author reply 209   [PMID:  21178342 ]

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