title: Anterior temporal artery sign in CT angiography predicts reduced fatal brain edema and mortality in acute M1 middle cerebral artery occlusions.
abstract: BACKGROUND
  Mortality in acute ischemic middle cerebral artery (MCA) stroke ranges from 5% to 45%. We identify a vascular imaging sign, presence of "prominent anterior temporal artery" on computed tomography (CT) angiography (CTA) and investigate whether it predicts mortality in acute M1-MCA occlusions.
  
  
  METHODS
  One hundred and two patients with acute M1-MCA occlusions from 2003-to 2007 were included in the study. A prominent anterior temporal artery arising from proximal M1 MCA was identified by two readers blinded to clinical outcome. Primary clinical outcome was survival (modified Rankin Scale [mRS] 0-5) at 3 months.
  
  
  RESULTS
  An anterior temporal artery arising from M1 MCA was present in 20/102 (20%). Eighteen of 20 (90%) patients with this sign survived at 3 months (mRS 0-5) when compared to 66/82 (80.4%) patients without the sign (odds ratio 2.2 CI(95) .5-10.4). The sign has a sensitivity of 21% (CI(95) .13-.25) but specificity of 89% (CI(95) .64-.98) in predicting survival at 3 months. Positive predictive value was 90% with likelihood ratio of 1.9 (CI(95) .9-7.6).
  
  
  CONCLUSIONS
  Presence of prominent anterior temporal artery in M1-MCA occlusions on CTA identifies a group of patients with reduced case fatality. The mechanism is likely related to a reduced chance of malignant cerebral edema.
authors.affiliation: Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada. bkmmenon@ucalgary.ca
authors.forename: Bijoy K
authors.initials: BK
authors.lastname: Menon
authors.forename: Simerpreet
authors.initials: S
authors.lastname: Bal
authors.forename: Jayesh
authors.initials: J
authors.lastname: Modi
authors.forename: Sung I I
authors.initials: SI
authors.lastname: Sohn
authors.forename: Timothy W J
authors.initials: TW
authors.lastname: Watson
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hill
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Demchuk
authors.forename: Mayank
authors.initials: M
authors.lastname: Goyal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001929:Brain Edema / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; D002533:Cerebral Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D013699:Temporal Arteries / Q000000981:diagnostic imaging*