RELATIONSHIP BETWEEN CEREBRAL BLOOD-FLOW AND THE DEVELOPMENT OF SWELLING AND LIFE-THREATENING HERNIATION IN ACUTE ISCHEMIC STROKE

Object. The purpose of this study was to determine whether cerebral bl ood flow (CBF) measurements in acute stroke could be correlated with t he subsequent development of cerebral edema and life-threatening brain herniation. Methods. Twenty patients with aggressively managed acute middle cerebral artery (MCA) territory strokes who underwent xenon-enh anced computerized tomography (Xe-CT) CBF scanning within 6 hours of o nset of symptoms were retrospectively reviewed. The relationship among CBF and follow-up CT evidence of edema and clinical evidence of brain herniation during the 36 to 96 hours following stroke onset was analy zed. Initial CT scans displayed abnormal findings in 11 patients (55%) , whereas the Xe-CT CBF scans showed abnormal findings in all patients (100%). The mean CBF in the symptomatic MCA territory was 10.4 ml/100 g/minute in patients who developed severe edema compared with 19 ml/1 00 g/minute in patients who developed mild edema (p < 0.05). The mean CBF in the symptomatic MCA territory was 8.6 ml/100 g/minute in patien ts who developed clinical brain herniation compared with 18 ml/100 g/m inute in those who did not (p < 0.01). The mean CBF in the symptomatic MCA territory that was 15 ml/100 g/minute or lower was significantly associated with the development of severe edema and herniation (p < 0. 05). Conclusions. Within 6 hours of acute MCA territory stroke, Xe-CT CBF measurements can be used to predict the subsequent development of severe edema and progression to clinical life-threatening brain hernia tion. Early knowledge of the anatomical and clinical sequelae of strok e in the acute phase may aid in the triage of such patients and alert physicians to the potential need for more aggressive medical or neuros urgical intervention.