title: Multiphasic helical computed tomography predicts subsequent development of severe brain edema in acute ischemic stroke.
abstract: 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.
authors.affiliation: Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea.
authors.forename: Soo Joo
authors.initials: SJ
authors.lastname: Lee
authors.forename: Kwang Ho
authors.initials: KH
authors.lastname: Lee
authors.forename: Dong Gyu
authors.initials: DG
authors.lastname: Na
authors.forename: Hong Sik
authors.initials: HS
authors.lastname: Byun
authors.forename: Yong Boem
authors.initials: YB
authors.lastname: Kim
authors.forename: Young-Min
authors.initials: YM
authors.lastname: Shon
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Cho
authors.forename: Jun
authors.initials: J
authors.lastname: Lee
authors.forename: Chin-Sang
authors.initials: CS
authors.lastname: Chung
authors.forename: Seung-Chyul
authors.initials: SC
authors.lastname: Hong
mesh_terms: 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