title: Post rtPA CT brain may not be mandatory in all stroke patients when resources are limited.
abstract: BACKGROUND
  Routine neuroimaging of the brain is performed after recombinant-tissue-plasminogen activator (rtPA) treatment in patients with acute ischemic stroke. However, in situation where resources are limited, it is not known if a follow-up computed tomography (CT) is beneficial for guiding the treatment plan or not. The purpose of this study is to investigate the need for a follow-up CT in patients with acute stroke after rtPA treatment.
  
  
  METHODS
  Patients who were treated with intravenous rtPA were included. Clinical symptoms/signs of the patients were evaluated at 24 h after rtPA treatment compared with baseline NIHSS. The need for a follow-up CT after rtPA treatment was assessed by comparison of the early clinical changes with the CT brain results that would affect the management plan: presence of hemorrhagic transformation, malignant MCA infarction, or large cerebellar infarction.
  
  
  RESULTS
  200 patients were included. 19 patients (9.5%) had complete recovery. CT post rtPA revealed no change in these patients. In 105 patients who had early improvement with NIHSS of 1-10 at 24 h, follow-up CT findings did not change the plan of management in 85%. Follow-up CTs may help in planning further management in 65% and 67% of the patients who had NIHSS>10 at 24 h and early worsening, respectively.
  
  
  CONCLUSIONS
  CT post rtPA may not be required in patients with early clinical recovery (NIHSS=0). However, in patients with residual severe deficit post rtPA or patients with early worsening or suspected posterior circulation stroke, CT post rtPA is still needed.
authors: Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand. pornpatr1@hotmail.com
authors: Pornpatr A
authors: PA
authors: Dharmasaroja
authors: Sombat
authors: S
authors: Muengtaweepongsa
authors: Permphan
authors: P
authors: Dharmasaroja
mesh_terms: D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000150:complications; D018450:Disease Progression; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006295:Health Resources; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000000981:diagnostic imaging; D007275:Injections, Intravenous; D020300:Intracranial Hemorrhages / Q000150:complications; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D013785:Thailand; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator