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(Stroke. 1998;29:2665.)
© 1998 American Heart Association, Inc.

Letters to the Editor

Is Visible Infarction on Computed Tomography Associated With an Adverse Prognosis in Acute Ischemic Stroke?

Gian Luigi Lenzi, MD

Department of Neurological Sciences, University of Roma I, Rome, Italy

To the Editor:

In the article by Wardlaw et al in the July issue of Stroke,¹ the outcome of stroke patients with an evident lesion on CT scan was compared with the outcome of stroke patients with no evident lesion. The result was that the prognosis for a patient with a "clinical stroke" evident on CT scan also was worse than the prognosis for a patient showing no evidence on CT scan of the lesion causing the clinical stroke.

However, obvious, it may due to a bias.

How severe were the patients without the CT lesion? How were the various times of their CT scans distributed. Was it in a manner similar to that shown in the article's Figure 2, for patients with CT lesions? In fact, patients with total anterior circulation infarcts (TACI) are more frequent (80%–95%) in the group with a positive CT, and vice-versa, lacunar infarcts (LACI) are more frequent in the group without positive CT scan (45%–60%): ie, the results may be due just to this unbalance. In fact, the sentence, "Patients who had a CT scan within a week of the stroke were more likely to be dead or dependent at 6 months than those scanned later ..." (p 1317), does not indicate a lethal effect of the CT scan but rather that in the Lothian Area physicians tend to ask for CT scan earlier in the more severe cases.

Regarding the number of patients (n=124; 10% of the registry) who did not have . . . [Full Text of this Article]

Joanna M. Wardlaw, MRCP, FRCR, MD; Stephanie C. Lewis, MSc Martin S. Dennis, FRCP, MD

Department of Clinical Neurosciences, Western General Hospital NHS Trust, Edinburgh, Scotland