Document Detail

The predictive value of early CT and angiography for fatal hemispheric swelling in acute stroke.
MedLine Citation:
PMID:  9613497     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Our goal was to analyze the predictive value of early CT and arteriographic morphologic criteria to achieve a more reliable prediction of fatal outcome in patients undergoing fibrinolytic stroke treatment. METHODS: In 74 patients with acute carotid artery stroke, early signs of cerebral ischemia were determined by CT. The site of vascular occlusion was identified by digital subtraction angiography (DSA). The patients were subsequently treated by intraarterial (n = 68) or intravenous (n = 6) fibrinolysis by means of recombinant tissue plasminogen activator (rt-PA), urokinase, or rt-PA combined with lys-plasminogen and followed-up for a period of 3 months. CT and DSA data were compared with the clinical course, with special emphasis on signs of early fatal deterioration (ie, death by intracranial mass effect) as determined by corresponding CT and clinical observations, occurring within 7 days after stroke. RESULTS: Seventeen patients died, all of intracranial mass effect, and all within a week after stroke. In nine of these fatalities, DSA revealed carotid "T" occlusion (CTO), which affected 19 patients. In five of the fatalities, a major early sign of ischemia (MESI, referring to cortical hypodensity in more than a third of the territory of the middle cerebral artery, as seen in 14 patients) was recognizable on the initial CT scan. This led to a higher predictive value and sensitivity of CTO relative to MESI for estimating early fatality. CONCLUSION: CTO as determined by DSA is a substantially better predictor of fatal outcome in patients undergoing intraarterial thrombolytic therapy than is MESI as determined by CT.
T Kucinski; C Koch; U Grzyska; H J Freitag; H Krömer; H Zeumer
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  AJNR. American journal of neuroradiology     Volume:  19     ISSN:  0195-6108     ISO Abbreviation:  AJNR Am J Neuroradiol     Publication Date:  1998 May 
Date Detail:
Created Date:  1998-07-27     Completed Date:  1998-07-27     Revised Date:  2008-02-14    
Medline Journal Info:
Nlm Unique ID:  8003708     Medline TA:  AJNR Am J Neuroradiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  839-46     Citation Subset:  IM    
Department of Neuroradiology, University Hospital Eppendorf, Hamburg, Germany.
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MeSH Terms
Acute Disease
Angiography, Digital Subtraction*
Brain Edema / mortality,  radiography*
Brain Ischemia / radiography,  therapy
Cerebral Angiography*
Cerebrovascular Disorders / mortality,  radiography*,  therapy
Middle Aged
Predictive Value of Tests
Thrombolytic Therapy
Tomography, X-Ray Computed*
Comment In:
AJNR Am J Neuroradiol. 1998 May;19(5):993-4   [PMID:  9613530 ]

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