Introduction. Localization, quality and evolution of early computed tomography (CT) signs in acute ischemic stroke were analyzed within the first hours and after 5 days. The aim of our study was to opinion prognostic value of CT changes for the clinical findings.
Material and methods. The examined group consisted of 55 patients (22 females and 33 males) aged 21–81 years (mean age 53 years) presented clinical signs of acute ischemic stroke involving the MCA territory. Using CT Somatom PLUS 4 by Siemens computer tomography of brain was performed during the first 12 hours (CT1) and after 5 days (CT2). The clinical features were scored immediately after admission (according to the Orgogozo scale) and after one month (according to the Orgogozo scale and Rankin scale).
Results. The initial CT scan showed early hypodensity in 36 patients (65.5%) and hyperdense midlle cerebral artery (MCA) sign in 9 patients (16%). Large hypodensity (> 1/3 MCA territory) was found in 29% (n = 16) cases, small (< 1/3 MCA territory) cortical hypodensity in 22% (n = 12) and small subcortical in 14.5% (n = 8). Computed tomography CT2 showed large infarct in 62% (n = 34), small infarct in 35% (n = 19) and lacunar in 3.6% (n = 2). Large infarct at CT 2 developed among all patients with large early hypodensity, above 50% with small early hypodensity and 37% with normal CT1. Small infarct at CT2 was observed among 9 patients with small early lesion at CT1 and 10 patients with normal CT1. Hemorrhagic transformation occurred in 16 patients (29%). In 11 of these 16 cases CT1 demonstrated large hypodensity and in 5 cases - HMCAS. Nine patients died during 30 days. In 5 of these patients CT1 detected large hypodensity, small subcortical lesion in 2 patients, small cortical lesion in 1 patient and was normal in 1 patient. Large hypodensity and small subcortical lesion at CT1 were associated with sevxere Orgogozo scores. The 31 patients with initial moderate neurological deficit had normal CT1 or small cortical hypodensity. A poor outcome (Rankin scale graded 4–5 or death) at 30 days after stroke was associated with large hypodensity, small subcortical hypodensity and HMCAS.
Conclusion. 1. Early CT signs during first 12 hours occur in 65.5% cases of acute ischemic stroke. 2. Hemorrhagic transformation develops of 2/3 patients with early large hypodensity. 3. Early large hypodensity or small subcortical lesion were preferably seen in patients who died within 30 days after stroke or exhibited at the same time severe neurological deficit. 4. Normal initial CT scan and the presence of small cortical lesion were related with favourable outcome in ischemic stroke.