Prognostic Value of Early CT Signs in Patients with Acute Middle Cerebral Artery Territory Infarction

Kim, Myeong Kyu; Park, Man Seok; Cho, Ki Hyun

Abstract

In the early treatment of the patients with acute cerebral infarction involving middle cerebral artery territory, intravenous anticoagulant or thrombolytic agent infusion is widely used to minimize the size of the infarcted area or neurological deficits. Sometimes, these therapeutic modalities cause devastating results because of their side effect of cerebral hemorrhage. It is generally known that early CT signs allow the prediction of early prognosis of MCA infarction as well as the location of a subsequent infarct. We designed this study to evaluate whether early CT signs provide the poor prognostic value or not. Of the 29 patients enrolled in the present study, 22 showed HSE, 18 LIR, 13 ALN, and 10 HMCAS on the initial CT scan. Each patient had more than 2 early CT signs on an average count. The mean NIHSS score was 15 (4 to 24) on admission (pretreatment), 11.4 (0 to 23) on the 3rd day and 7.1 (0 to 18) on the 30th day after symptom onset. The decreasing tendency of this NIHSS score, according to the time sequence, had a statistical significance (p= 0.000; Friedman test). There was no difference in the baseline NIHSS score between the group treated with interventional urokinase infusion (mean = 15) and the group treated with classic heparinization (mean = 15). On the 3rd day and the 30th day after symptom onset, however, the mean NIHSS scores were 7.9 and 4.1 for the former and 15.1 and 10 for the latter, respectively. The discrepancy of the clinical outcome represented by the NIHSS score between the two groups was also statistically significant (p= 0.007, General linear model, repeated ANOVA test with time). The mean time interval between symptom onset and CT examination was 280 min. in the group treated with interventional urokinase infusion and 203 min. in the group treated with classic heparinization. But it showed that this difference in the mean time interval couldn't affect the clinical outcome. These results suggest that the presence of early MCA signs in patients with acute MCA infarct may not be a high risk factor for hemorrhagic transformation in acute intraarterial thrombolytic therapy any longer. Therefore, a more active therapeutic modality to restore the neural function in the penumbra zone needs to be considered in acute stoke therapy.