American Journal of Neuroradiology, Vol 15, Issue 1 9-15, Copyright © 1994 by American Society of Neuroradiology
ARTICLES |
Sensitivity and prognostic value of early CT in occlusion of the middle cerebral artery trunk
R von Kummer, U Meyding-Lamade, M Forsting, L Rosin, K Rieke, W Hacke and K Sartor
Department of Neuroradiology, University of Heidelberg, Germany.
PURPOSE: To investigate the incidence and prognostic value of local brain swelling, the extent of parenchymal hypodensity, and the hyperdense middle cerebral artery sign as shown by CT within the first 5 hours after the onset of symptoms in patients with angiographically proved middle cerebral artery trunk occlusions. METHODS: Fifty-three patients were studied prospectively with CT 46 to 292 minutes (median, 120; mean, 134 +/- 59) after symptom onset and scored clinically at admission and 4 weeks later. All patients were treated with recombinant tissue plasminogen activator (30 to 100 mg). RESULTS: Early CT showed parenchymal hypodensity in 43 patients (81%), local brain swelling in 20 patients (38%), and hyperdensity of the middle cerebral artery trunk in 25 patients (47%). Hypodensity covering more than 50% of the middle cerebral artery territory had an 85%, local brain swelling a 70%, and the hyperdense middle cerebral artery sign a 32% positive predictive value for fatal clinical outcome. Specificity of these findings for fatal outcome was 94%, 83%, and 51%, respectively, and sensitivity was 61%, 78% and 44%, respectively. CONCLUSIONS: Early CT in acute middle cerebral artery trunk occlusion is highly predictive for fatal clinical outcome if there is extended hypodensity or local brain swelling despite aggressive therapeutic attempts such as thrombolysis or decompressive surgery.
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A. D. Firlik, G. Rubin, H. Yonas, and L. R. Wechsler Relation between cerebral blood flow and neurologic deficit resolution in acute ischemic stroke Neurology, July 1, 1998; 51(1): 177 - 182. [Abstract] [Full Text] [PDF]
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D. Toni, M. Fiorelli, E. M. Zanette, M. L. Sacchetti, A. Salerno, C. Argentino, M. Solaro, and C. Fieschi Early Spontaneous Improvement and Deterioration of Ischemic Stroke Patients : A Serial Study With Transcranial Doppler Ultrasonography Stroke, June 1, 1998; 29(6): 1144 - 1148. [Abstract] [Full Text] [PDF]
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M. Goertler, R. Kross, M. Baeumer, S. Jost, R. Grote, S. Weber, and C.-W. Wallesch Diagnostic Impact and Prognostic Relevance of Early Contrast-Enhanced Transcranial Color-Coded Duplex Sonography in Acute Stroke Stroke, May 1, 1998; 29(5): 955 - 962. [Abstract] [Full Text] [PDF]
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W.-D. Heiss, M. Grond, A. Thiel, M. Ghaemi, J. Sobesky, J. Rudolf, B. Bauer, and K. Wienhard Permanent Cortical Damage Detected by Flumazenil Positron Emission Tomography in Acute Stroke Stroke, February 1, 1998; 29(2): 454 - 461. [Abstract] [Full Text] [PDF]
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A. D. Firlik, A. M. Kaufmann, L. R. Wechsler, K. S. Firlik, M. B. Fukui, and H. Yonas Quantitative Cerebral Blood Flow Determinations in Acute Ischemic Stroke : Relationship to Computed Tomography and Angiography Stroke, November 1, 1997; 28(11): 2208 - 2213. [Abstract] [Full Text]
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R. v. Kummer and J. Weber Brain and vascular imaging in acute ischemic stroke: The potential of computed tomography Neurology, November 1, 1997; 49(5_Suppl_4): S52 - S55. [Full Text] [PDF]
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C. R. Jack Jr, R. C. Petersen, Y. C. Xu, S. C. Waring, P. C. O'Brien, E. G. Tangalos, G. E. Smith, R. J. Ivnik, and E. Kokmen Medial temporal atrophy on MRI in normal aging and very mild Alzheimer's disease Neurology, September 1, 1997; 49(3): 786 - 794. [Abstract] [Full Text] [PDF]
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A. Culebras, C. S. Kase, J. C. Masdeu, A. J. Fox, R. N. Bryan, C. B. Grossman, D. H. Lee, H. P. Adams, W. Thies, and E. O. Members Practice Guidelines for the Use of Imaging in Transient Ischemic Attacks and Acute Stroke : A Report of the Stroke Council, American Heart Association Stroke, July 1, 1997; 28(7): 1480 - 1497. [Full Text]
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V. Larrue, R. von Kummer, G. del Zoppo, and E. Bluhmki Hemorrhagic Transformation in Acute Ischemic Stroke : Potential Contributing Factors in the European Cooperative Acute Stroke Study Stroke, May 1, 1997; 28(5): 957 - 960. [Abstract] [Full Text]
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S. Schwab, E. Junger, M. Spranger, A. Dorfler, F. Albert, H. H. Steiner, and W. Hacke Craniectomy: An aggressive treatment approach in severe encephalitis Neurology, February 1, 1997; 48(2): 412 - 417. [Abstract] [Full Text] [PDF]
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C. Motto, E. Aritzu, E. Boccardi, C. De Grandi, A. Piana, and L. Candelise Reliability of Hemorrhagic Transformation Diagnosis in Acute Ischemic Stroke Stroke, February 1, 1997; 28(2): 302 - 306. [Abstract] [Full Text]
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R. Tarr, C. L. Taylor, W. R. Selman, J. S. Lewin, and D. Landis Good clinical outcome in a patient with a large CT scan hypodensity treated with intra-arterial urokinase after an embolic stroke Neurology, October 1, 1996; 47(4): 1076 - 1078. [Abstract] [Full Text] [PDF]
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T. Moulin, F. Cattin, T. Crepin-Leblond, L. Tatu, D. Chavot, M. Piotin, J. F. Viel, L. Rumbach, and J. F. Bonneville Early CT signs in acute middle cerebral artery infarction: Predictive value for subsequent infarct locations and outcome Neurology, August 1, 1996; 47(2): 366 - 375. [Abstract] [Full Text] [PDF]
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S. Warach, J. R. Ives, G. Schlaug, M. R. Patel, D. G. Darby, V. Thangaraj, R. R. Edelman, and D. L. Schomer EEG-triggered echo-planar functional MRI in epilepsy Neurology, July 1, 1996; 47(1): 89 - 93. [Abstract] [Full Text] [PDF]
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A. Pitkanen, M. Laakso, R. Kalviainen, K. Partanen, P. Vainio, M. Lehtovirta, P. Riekkinen Sr., MD, P, and H. Soininen Severity of hippocampal atrophy correlates with the prolongation of MRI T sub 2 relaxation time in temporal lobe epilepsy but not in Alzheimer's disease Neurology, June 1, 1996; 46(6): 1724 - 1730. [Abstract] [Full Text] [PDF]
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J. Rother, F. Guckel, W. Neff, A. Schwartz, and M. Hennerici Assessment of Regional Cerebral Blood Volume in Acute Human Stroke by Use of Single-Slice Dynamic Susceptibility Contrast-Enhanced Magnetic Resonance Imaging Stroke, June 1, 1996; 27(6): 1088 - 1093. [Abstract] [Full Text]
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W. Hacke, S. Schwab, M. Horn, M. Spranger, M. De Georgia, and R. von Kummer 'Malignant' Middle Cerebral Artery Territory Infarction: Clinical Course and Prognostic Signs Arch Neurol, April 1, 1996; 53(4): 309 - 315. [Abstract] [PDF]
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D. Toni, M. Fiorelli, S. Bastianello, M. L. Sacchetti, G. Sette, C. Argentino, E. Montinaro, and L. Bozzao Hemorrhagic transformation of brain infarct: Predictability in the first 5 hours from stroke onset and influence on clinical outcome Neurology, February 1, 1996; 46(2): 341 - 345. [Abstract] [Full Text] [PDF]
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J.C. Baron, R. von Kummer, and G.J. del Zoppo Treatment of Acute Ischemic Stroke : Challenging the Concept of a Rigid and Universal Time Window Stroke, December 1, 1995; 26(12): 2219 - 2221. [Full Text]
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W. Hacke, M. Kaste, C. Fieschi, D. Toni, E. Lesaffre, R. von Kummer, G. Boysen, E. Bluhmki, G. Hoxter, M.-H. Mahagne, et al. Intravenous Thrombolysis With Recombinant Tissue Plasminogen Activator for Acute Hemispheric Stroke: The European Cooperative Acute Stroke Study (ECASS) JAMA, October 4, 1995; 274(13): 1017 - 1025. [Abstract] [PDF]
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D. Toni, M. Fiorelli, M. De Michele, S. Bastianello, M. L. Sacchetti, E. Montinaro, E. M. Zanette, and C. Argentino Clinical and Prognostic Correlates of Stroke Subtype Misdiagnosis Within 12 Hours From Onset Stroke, October 1, 1995; 26(10): 1837 - 1840. [Abstract] [Full Text]
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D. Toni, M. Fiorelli, M. Gentile, S. Bastianello, M. L. Sacchetti, C. Argentino, C. Pozzilli, and C. Fieschi Progressing Neurological Deficit Secondary to Acute Ischemic Stroke: A Study on Predictability, Pathogenesis, and Prognosis Arch Neurol, July 1, 1995; 52(7): 670 - 675. [Abstract] [PDF]
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R. von Kummer, R. Holle, L. Rosin, M. Forsting, and W. Hacke Does Arterial Recanalization Improve Outcome in Carotid Territory Stroke? Stroke, April 1, 1995; 26(4): 581 - 587. [Abstract] [Full Text]
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M. Forsting, W. Reith, W.-R. Schabitz, S. Heiland, R. von Kummer, W. Hacke, and K. Sartor Decompressive Craniectomy for Cerebral Infarction : An Experimental Study in Rats Stroke, February 1, 1995; 26(2): 259 - 264. [Abstract] [Full Text]
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M. Horn, F. Seger, and W. Schlote Neuron-Specific Enolase in Gerbil Brain and Serum After Transient Cerebral Ischemia Stroke, February 1, 1995; 26(2): 290 - 297. [Abstract] [Full Text]
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