Systemic thrombolysis based on CT or MRI stroke imaging.
BACKGROUND
Computed tomography (CT) and magnetic resonance imaging (MRI) are tools of investigation in acute stroke. We wondered if the additional information offered by MRI outweighs the disadvantage of its longer scanning duration for systemic thrombolysis.


METHODS
Two hundred ninety-four consecutive patients (66 +/- 13 years) were subjected to thrombolysis between 1999 and 2004. Inclusion criteria were ischemic infarction, scoring at entry and discharge with the NIH stroke scale and modified Rankin scale, systemic thrombolysis within 3 hours after symptom onset, multimodal MRI or standard CT. Subgroup analysis of 42 patients compared standard CT with CT and CT angiography.


RESULTS
Patients were similarly affected on admission (P > .1). At discharge, 6 days after stroke onset, the patients investigated with MRI were less impaired than those investigated with standard CT (P < .05). Symptomatic hemorrhage was rare in both groups. Also, patients investigated with CT and CT angiography were less impaired at discharge than those with standard CT (P < .02). A multifactorial regression showed that systolic blood pressure, glucose level and initial neurological impairment determined the neurological outcome at discharge.


CONCLUSIONS
Systolic blood pressure, glucose level and neurological impairment but not the imaging modality determined the neurological outcome following systemic thrombolysis in the 3-hour window.
Veronel
Dimitro
D
Department of Neurology, University Hospital Düsseldorf, Düsseldorf, Germany.
Ringelstein
Adrian
A
Cohnen
Matthias
M
Yong
Mei
M
Siebler
Mario
M
Seitz
Rüdiger J
RJ
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000175:diagnosis* / Q000188:drug therapy*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000187:drug effects; D011446:Prospective Studies; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome
D001786:Blood Glucose; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator