Stroke, Vol 22, 1245-1253, Copyright © 1991 by American Heart Association
SH Horowitz, JL Zito, R Donnarumma, M Patel and J Alvir
BACKGROUND AND PURPOSE: Modern management of acute stroke necessitates
early diagnosis. To this end, we sought to delineate the radiographic
features of focal hemispheric infarction within 5 hours of ictus. METHODS:
Fifty patients, ages 54-79, with ischemic strokes productive of at least
hemiparesis underwent computed tomographic scanning and cerebral
angiography (n = 38) or carotid ultrasound (n = 12). Radiographic lesions
were characterized for location, size, and pathophysiology. RESULTS: Acute
abnormalities, hypodensity, and mass effect were seen in 56% of scans and
confirmed on a second scan 5-7 days later. Intracranial angiographic
abnormalities occurred in 61% of patients: arterial occlusions in 45% and
delayed arterial filling in 16%. Hemorrhagic infarctions occurred in 26% of
second scans and were associated with mass effect (100%) and arterial
occlusions (89%). Infarcts with hemorrhagic transformation were larger on
both scans than those without (p = 0.001). Of four patients with
infarctions in watershed territories on the scans, two had middle cerebral
artery occlusions on angiography, thereby questioning the specificity of
such scan lesions to low-flow states. CONCLUSIONS: We conclude that
cerebral infarctions are often visible on early scans, but their locations
may not be etiologically determinative. The infarcts associated with
intracranial arterial occlusions (45%) were of thromboembolic origin, but,
given current controversies as to the pathophysiology of lacunar and
watershed infarctions, we cannot ascertain the etiology in the remainder.
These findings are relevant to the new stroke therapies that require
administration in the first hours after infarction.
ARTICLES
Computed tomographic-angiographic findings within the first five hours of cerebral infarction
Department of Neurology, Long Island Jewish Medical Center, New Hyde Park, NY 11042.
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