Extremely early computed tomography signs in hyperacute ischemic stroke as a predictor of parenchymal hematoma.

BACKGROUND: In acute ischemic stroke, thrombolysis with intravenous recombinant tissue plasminogen activator is more effective when given within 90 min of onset compared to that given later than 90 min. However, the significance of early CT signs (ECTs) during such early periods has not yet been fully clarified. We investigated the usefulness of ECTs within 90 min for predicting parenchymal hematoma (PH) in patients without thrombolysis.

METHODS: We evaluated 212 consecutive patients with initial ischemic stroke in the anterior cerebral circulation who underwent the first CT within 6 h of onset. The patients were divided into 3 groups according to the interval from onset to CT: within 90 min (group A, n = 90), 91-180 min (group B, n = 76) and 181-360 min (group C, n = 46). Patients who had received thrombolytic therapy were excluded. ECTs were evaluated according to the Alberta Stroke Program Early CT Score (ASPECTS). The relationships between ECTs and the subsequent development of PH were compared among the groups.

RESULTS: In patients with ASPECTS values between 0 and 7, PH was developed more frequently in group A (35%) than in groups B (14%) or C (15%) (group A vs. B: p = 0.036, group A vs. C: p = 0.094). In group A, atrial fibrillation, elevated pretreatment blood pressure and ASPECTS < or =7 were independent predictors of PH.

CONCLUSIONS: The manifestation of ECTs as represented by ASPECTS < or =7 within 90 min after stroke appears to indicate a high risk of PH.