Correlation of Clinical Outcome and CT/MR in Acute Stroke Patients with Normal Cerebral Angiography
Objective: To examine clinical outcome of patients presenting with acute stroke who have normal cerebral angiography. Methods: From November 1994 to June 2000, patients with stroke onset of less than 6 hours underwent cerebral angiography prior to intra-arterial thrombolysis. Seventeen patients (15 male, 2 female; mean age 64, range 42–89) with a discharge diagnosis of stroke had normal cerebral angiography. Admission NIH stroke scale (NIHSS) and Rankin score at discharge were obtained in all patients, as well as follow-up CT and/or MR greater than 24 hours after symptom onset. Good outcome was defined as a Rankin score of 0,1, or 2. Poor outcome was defined as a Rankin score of 3 or greater. Patients were divided into 2 categories based on CT/MR findings: lacunar infarct (single or multiple) and cortical infarct. Discharge Rankin scores were correlated with admission NIHSS and findings on follow-up CT/MR. Results: All patients had a discharge Rankin score of 4 or less. Eleven (65%) patients had a poor outcome at discharge and 6 (35%) had a good outcome at discharge. No patient had a normal follow-up CT/MR. All patients with a poor outcome at discharge had a new infarct on follow-up CT/MR. Seven had a new lacunar infarct and 4 had a new cortical infarct. Five (83%) of the 6 patients with good outcome at discharge had new infarcts, 3 lacunar, and 2 cortical. The sixth patient in this group had no new infarct. Admission NIHSS did not correlate with a poor outcome at discharge (Rankin >2; p>0.05, Mann-Whitney). Conclusion: Our results indicate that the majority of patients presenting with acute stroke who have a normal angiogram will have a poor clinical outcome at discharge. Niether admission NIHSS nor follow-up CT/MR were found to reliably predict patient outcome at discharge.