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(Stroke. 1999;30:1974-1981.)
© 1999 American Heart Association, Inc.

Letters to the Editor

Ischemic Stroke and Tissue Hypodensity on Computed Tomography

Rüdiger von Kummer, MD

Department of Neuroradiology, Technische Universität, Dresden, Germany

Key Words: stroke, ischemic • tomography, x-ray computed case-control studies

	Introduction

 
To the Editor:

Clinical experience and experimental data have shown that early identification of patients with a large ischemic brain edema and subsequent hemicraniectomy can decrease mortality and morbidity.^{1 2} I read with great interest the article by Haring and colleagues³ and appreciate the efforts of the authors to find CT criteria that could early and reliably discriminate acute stroke patients with a malignant course and the potential benefit from craniectomy for those with a more favorable prognosis. I am afraid, however, that the authors did not really meet this goal.

The authors used a case-control design and defined the patients with malignant course by their vascular findings (occlusion of the internal carotid artery or middle cerebral artery [MCA] trunk) and by tentorial herniation caused by brain edema within 24 to 96 hours after admission. The authors did not reveal whether the matched controls had the same type of arterial occlusion or why they chose older patients (median age 71 versus 64 years). They found that an attenuated corticomedullary contrast covering at least the entire MCA territory is the only radiological feature that yields both high specificity and sensitivity for a malignant course compared with other CT findings, such as parenchymal hypodensity and signs of focal brain swelling. They correctly stated that the attenuation of the corticomedullary contrast is caused by cortical hypodensity. In their cohort of 31 patients with malignant course, 27 patients showed a hypodensity of the entire MCA territory cortex. They found, however, only 18 patients with a . . . [Full Text of this Article]

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				P L Tan, D King, C J Durkin, T M Meagher, and D Briley Diffusion weighted magnetic resonance imaging for acute stroke: practical and popular. Postgrad. Med. J., April 1, 2006; 82(966): 289 - 292. [Abstract] [Full Text] [PDF]