Greater Cincinnati/Northern Kentucky Stroke Study - Volume of first-ever ischemic stroke among blacks in a population-based study

Background and Purpose - The Volume of ischemic stroke on CT scans has been studied in a standardized fashion in acute stroke therapy trials with medi an volumes between 10.5 to 55 cm(3). The volume of first-ever ischemic stro ke in the population is not known. Methods - The first phase of the population-based Greater Cincinnati/Northe rn Kentucky Stroke Study identified all ischemic strokes occurring in black s in the greater Cincinnati region between January and June of 1993. The pa tients in this phase of the study who had a first-ever ischemic clinical st roke were identified, and the volume of ischemic stroke was measured. Results - There were 257 verified clinical cases of ischemic stroke, of whi ch 181 had a first-ever ischemic infarct. imaging was available for 150 of these patients, and 79 had an infarct on the CT or MRI study that was defin itely or possibly related to the clinical symptoms. For these patients, vol umetric measurements were performed by means of the modified ellipsoid meth od. The median volume of first-ever ischemic stroke for the 79 patients was 2.5 cm(3) (interquartile range, 0.5 to 8.8 cm(3)). There was a significant relation between location of lesion and infarct size (P <0.001) and betwee n volume and mechanism of stroke (P=0.001), Conclusions - The volume of first-ever ischemic stroke among blacks in our population-based study is smaller than has been previously reported in acut e stroke therapy trials. The large proportion of small, mild strokes in bla cks may be an important reason for the low percentage of patients who meet the inclusion criteria for tissue plasminogen activator. Further study is n ecessary to see if these results are generalizable to a multiracial populat ion.