Stroke, Vol 23, 317-324, Copyright © 1992 by American Heart Association
D Leys, JP Pruvo, O Godefroy, P Rondepierre and X Leclerc
BACKGROUND AND PURPOSE: Early noncontrast computed tomographic scans may
visualize a hyperdense middle cerebral artery before the infarct becomes
visible. This sign disappears within a few days, corresponds to the clot
itself, and might be associated with a poor prognosis. The aim of the study
was to determine its prevalence, diagnostic value, relationship to
demographic data, ability to separate embolic from nonembolic causes,
short-term prognostic value, evolution over time, and relationship to
arterial occlusion on angiography. METHODS: We performed this study using
computed tomographic scans performed within 12 hours after onset in 272
consecutive unselected patients with a first acute cerebrovascular event.
RESULTS: Seventy-three subjects had the hyperdense middle cerebral artery
sign, leading to a prevalence of 26.8% in the whole group and 41.2% in
patients with a middle cerebral artery infarct. Specificity was 100%, but
sensitivity was only 30%. This sign was not dependent on cerebrovascular
risk factors, but was more likely to occur in cortical and in large, deep,
middle cerebral artery infarcts (p less than 0.01). It provided only a 3.5%
gain in predicting death, and one fifth of patients with the sign recovered
within 2 weeks; this sign was not an independent variable of poor outcome
on multiple linear regression. It spontaneously disappeared within a few
days and was always related to an occlusion of the middle cerebral artery
in patients who underwent early angiography. CONCLUSIONS: The hyperdense
middle cerebral artery sign is useful in the diagnosis of middle cerebral
artery occlusion but does not always predict a poor prognosis.
ARTICLES
Prevalence and significance of hyperdense middle cerebral artery in acute stroke
Department of Neurology, University Hospital, Lille, France.
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