Correlation of neurologic dysfunction with CT findings in early acute stroke

Objective: To determine the frequency of early computed tomographic (CT) fi ndings of ischemia and their relationship to symptom duration and neurologi c dysfunction within 3 hours of ischemic stroke. Methods: The CT scans of 3 9 acute stroke patients were evaluated for signs of early ischemic change w ithin 3 hours of symptom onset and without knowledge of the patient's neuro logic deficit or results of a 24 hour follow-up post-thrombolysis CT. Early CT signs of acute ischemic change or thromboembolism were hypoattenuation of the insular ribbon, obscuration of the lentiform nucleus, cortical hypod ensity/effacement, and hyperdense middle cerebral artery sign. Results: Sig ns of acute ischemic change were seen on the baseline scan in 25/39 patient s (64%), Hypoattenuation of the insular ribbon was seen in 11 patients, obs curation of the lentiform nucleus in 13, cortical hypodensity/effacement in 13, and hyperdense middle cerebral artery sign in 7. The prevalence of ear ly ischemic signs was directly associated with increasing neurologic disabi lity at the time of presentation. No clear relationship existed between sym ptom duration and the presence of CT signs. Conclusions: Evidence of cerebr al ischemia is frequently seen on CT within 3 hours of symptom onset. The d egree of neurologic disability correlates with CT signs of ischemia.