Reversal of dense signs predicts recovery in acute ischemic stroke.
OBJECTIVE
The presence of computed tomography dense signs in acute ischemic stroke indicates thrombosis. We sought to ascertain whether reversibility of these signs provides additional prognostic information.


METHODS
Baseline and follow-up imaging was obtained from 18 patients who had received intravenous abciximab and heparin as part of an ongoing safety study in acute ischemic stroke. Presence of signs and their reversal were assessed and correlated with mortality and 90-day outcome.


RESULTS
Fourteen of the 18 patients had dense dot signs in the middle cerebral or dense signals in the basilar artery on baseline computed tomography. The signs reversed in 7 (group 1) and persisted in 7 (group 2). Mean baseline National Institutes of Health Stroke Scale did not differ. All 7 in group 1 were alive at 90 days, with 3 of 7 alive in group 2. Ninety-day modified Rankin Scale was lower in group 1 (1.9+/-1.57) compared with group 2 (4.6+/-1.9; P=0.01).


CONCLUSIONS
The reversal of dense signs predicts a much better outcome than its persistence. These signs should receive additional attention for both their diagnostic and prognostic importance.
Mandava
Pitchaiah
P
Department of Neurology, Baylor College of Medicine, The Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA. pmandava@bcm.tmc.edu
Kent
Thomas A
TA
D000077284:Abciximab; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D007511:Ischemia / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000378:metabolism; D011379:Prognosis; D020521:Stroke / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology*; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000473:pathology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D005343:Fibrinolytic Agents; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D006493:Heparin; D000077284:Abciximab