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Stroke, Vol 24, 1322-1329, Copyright © 1993 by American Heart Association
SK Hanson, JC Grotta, H Rhoades, HD Tran, LM Lamki, BJ Barron and WJ Taylor
BACKGROUND AND PURPOSE: New therapeutic interventions for acute ischemic
stroke are aimed at improving cerebral blood flow in the first 3 to 6 hours
after symptom onset. Single-photon emission-computed tomography (SPECT)
performed in the setting of clinical therapeutic trials may give us a
better understanding of the physiological response to new forms of
treatment and could impact acute management decisions. METHODS: We
prospectively studied 15 patients with hemispheric ischemic stroke with
SPECT within 6 hours of symptom onset and again at 24 hours. The ischemic
defect was assessed in a semiquantitative manner that used
computer-generated regions of interest (SPECT graded scale). This measure
was correlated with clinical presentation (National Institutes of Health
[NIH] Stroke Scale), initial clinical course (change in NIH Stroke Scale),
long-term outcome (Barthel Index at 3 months), and complications of
cerebral hemorrhage and edema. RESULTS: The severity of the SPECT graded
scale on the admission scan correlated with the severity of neurological
deficit (admission NIH Stroke Scale) (P < .05) and was positively
associated with poor long-term outcome as measured with the Barthel Index
(P < .001) and the complications of cerebral hemorrhage and massive
cerebral edema (P < .005). In fact, there was a threshold value for the
SPECT graded scale above which all patients suffered poor long-term outcome
and the complications of cerebral hemorrhage and edema. CONCLUSIONS. The
measurement of an ischemic defect using SPECT is a valid assessment of
hemispheric stroke severity in the hyperacute setting and may be useful for
selecting or stratifying patients in clinical therapeutic trials.
ARTICLES
Value of single-photon emission-computed tomography in acute stroke therapeutic trials
Department of Neurology, University of Texas Health Science Center, Houston 77030.
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