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Significance of Early CT Signs in Acute Stroke

2002; Karger Publishers; Volume: 13; Issue: 1 Linguagem: Inglês

10.1159/000047746

1421-9786

Assia Jaillard, Marc Hommel, Alison E. Baird, Italo Linfante, R. Llinás, Louis R. Caplan, Robert R. Edelman, Steven Warach,

Cerebrovascular and Carotid Artery Diseases

<i>Objective:</i> To study the pathophysiology of early CT signs. <i>Background:</i> Early CT signs, due to an increase in tissue water content, are commonly attributed to cytotoxic edema and development of irreversible injury. This may have important implications for thrombolysis. <i>Methods:</i> In patients with acute ischemic stroke in the middle cerebral artery territory, the areas of early CT signs and diffusion weighted imaging (DWI) hypersignal were independently assessed and drawn on a standardized atlas. Then, patients were classified into three groups (early CT signs larger than, similar to or smaller than DWI hypersignal) and compared with perfusion weighted imaging (PWI). <i>Results:</i> Of 16 patients, CT scanning was performed with a median time of 3 h after onset and early CT scan signs were recorded in 10/16 patients (62.5%). DWI signal hyperintensity was present in 15/16 (94%) patients. In 7/16 (43%) patients, the area with early CT scan signs was larger than the DWI lesion (‘CT-larger group’). Only in 2/16 (12%) patients were the areas matching (‘matching group’). In 7/16 (43%) the DWI lesion was larger than the early CT scan signs area (‘DWI-larger group’). When compared with PWI, the areas of early CT signs were larger than DWI hypersignal and were matching with PWI abnormalities (rMTT) in 2 cases, suggesting that they may represent a reversible process. <i>Conclusions:</i> Early CT signs might have a potential dual fate: infarction or reversibility. Other techniques of recognizing reversible ischemic damage, such as DWI-PWI, are needed to improve acute stroke diagnosis and management.