Multiphasic helical computed tomography predicts subsequent development of severe brain edema in acute ischemic stroke.
OBJECTIVE
To evaluate the use of multiphasic helical computed tomography (CT) in predicting subsequent development of severe brain edema in patients with acute middle cerebral artery (MCA) stroke.


METHODS
Case-control study.


METHODS
Tertiary referral hospital.


METHODS
We studied 31 patients with acute MCA stroke who had a baseline National Institutes of Health Stroke Scale score of 15 or higher within 6 hours of symptom onset. Sequential 4-phasic enhanced helical CT scans were performed after taking precontrast CT scans. The severity of perfusion deficit was graded as "severe" or "moderate" depending on collateral blood flow.


METHODS
Patients were classified as having severe brain edema if they showed signs of uncal herniation or deterioration with mass effect leading to hemicraniectomy.


RESULTS
Severe brain edema developed in 10 patients (32%). Severe perfusion deficit greater than 50% of the presumed MCA territory on multiphasic helical CT was more often found in patients with severe brain edema than in those without (8 of 10 vs 4 of 21, P =.002). In contrast, parenchymal hypodensity greater than 50% on precontrast CT was observed only in 5 patients with severe brain edema (5 of 10 vs 4 of 21, P =.10). Additional involvement of the anterior or posterior cerebral artery territory was found on multiphasic CT (6 of 10 vs 0 of 21, P <.001) and on precontrast CT (4 of 10 vs 0 of 21, P =.007) only in patients with severe brain edema.


CONCLUSIONS
Multiphasic helical CT is more useful than precontrast CT for predicting subsequent severe brain edema in acute MCA stroke based on the findings of severe perfusion deficit greater than 50% of the MCA territory and additional involvement of the anterior or posterior cerebral artery territory.
Lee
Soo Joo
SJ
Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea.
Lee
Kwang Ho
KH
Na
Dong Gyu
DG
Byun
Hong Sik
HS
Kim
Yong Boem
YB
Shon
Young-Min
YM
Cho
Soo-Jin
SJ
Lee
Jun
J
Chung
Chin-Sang
CS
Hong
Seung-Chyul
SC
D000046:Academic Medical Centers; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging; D001929:Brain Edema / Q000000981:diagnostic imaging*; D018450:Disease Progression; D004677:Encephalocele / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006723:Hong Kong; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011379:Prognosis; D011856:Radiographic Image Enhancement; D012307:Risk Factors; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed