Early CT Scan Signs in Acute Middle Cerebral Artery Territory Ischemic Stroke

ABSTRACT

It has been known that CT scan shows only a few abnormalities within the first hours of acute ischemic stroke. We investigated the frequency and the predictive value of early CT scan signs of ischemia for late infarct locations In acute middle cerebral artery (MCA) territory stroke. Precontrast CT (PCT) scans were performed in the 35 consecutive patients with cerebral anterior circulation infarction within 6 hours after the onset of stroke. We confirmed MCA territory infarction on follow-up PCT or MRI within 3 to 7 days. The locations of infarction were classified deep, superficial, and total (deep and superficial) infarction on follow-up PCT or MRI. The initial PCT was abnormal in 74.3% (26/3s). The locations of infarction were deep in 10, superficial in 8, and total in 14. Abnormal findings of the initial PCT were attenuation of lentiform nucleus (ALN) in 18 patients, loss of insular ribbon (LIR) in 11, hemispheric sulcus effacement (HSE) in 10, hyperdense MCA sign (HMCAS) in 2, and small subcortical low attenuation in 2. Of 24 patients with late infarction in basal ganglia 18 (75%) had ALN on initial PCT. Of 17 patients with late infarction in insular cortex 11 (65%) had LIR. Of IS patients with late infarction in cerebral cortex 10 (67%) had HSE. Early PCT signs were correlated with late locations of MCA territory infarction : ALN - deep infarct, HSE - superficial infarct, LIR - superficial infarct, HMCAS - total infarction. Our findings suggest that PCT frequently discloses abnormalities during the first hours of ischemic stroke. Early signs of ischemia on the initial PCT scan may predict the late infarct locations on follow-up study.