Abstract
Objectives. Whether acute stroke patients with major early infarct signs on computed tomography (CT) should be treated with intravenous (IV) thrombolysis remains controversial. The authors sought to define the outcomes in 5 consecutive patients who were not treated with IV thrombolysis, according to established guidelines. Methods. The authors retrospectively analyzed the outcomes of a consecutive series of 5 patients evaluated by an acute stroke team at a university medical center and who were denied IV tissue plasminogen activator due to early CT changes. Results. Five patients with a median National Institutes of Health Stroke Scale score of 22 (range 20-28) were evaluated. Despite aggressive care (e.g., hemicraniectomy), 2 patients died owing to herniation, 1 patient died of cardiac causes, and neither of the 2 surviving patients achieved a 3-month Rankin score below 4 (moderately severe disability). Conclusions. Given the poor prognosis of patients with hemispheric stroke and early CT changes, alternative treatment modalities such as intra-arterial thrombolysis, early hemicraniectomy, and neuroprotective therapy should be vigorously pursued.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 40-43 |
| Number of pages | 4 |
| Journal | Journal of Neuroimaging |
| Volume | 11 |
| Issue number | 1 |
| State | Published - 2001 |
| Externally published | Yes |
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Keywords
- Acute ischemic stroke
- Cerebral infarction
- Computed tomography
- Hemicraniectomy
- Thrombolysis
- Tissue plasminogen activator
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging
- Clinical Neurology
- Neuroscience(all)
- Radiological and Ultrasound Technology
Cite this
Poor prognosis of acute stroke patients denied thrombolysis due to early CT findings. / Joshi, Nishith; Chaturvedi, Seemant; Coplin, William M.
In: Journal of Neuroimaging, Vol. 11, No. 1, 2001, p. 40-43.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Poor prognosis of acute stroke patients denied thrombolysis due to early CT findings
AU - Joshi, Nishith
AU - Chaturvedi, Seemant
AU - Coplin, William M.
PY - 2001
Y1 - 2001
N2 - Objectives. Whether acute stroke patients with major early infarct signs on computed tomography (CT) should be treated with intravenous (IV) thrombolysis remains controversial. The authors sought to define the outcomes in 5 consecutive patients who were not treated with IV thrombolysis, according to established guidelines. Methods. The authors retrospectively analyzed the outcomes of a consecutive series of 5 patients evaluated by an acute stroke team at a university medical center and who were denied IV tissue plasminogen activator due to early CT changes. Results. Five patients with a median National Institutes of Health Stroke Scale score of 22 (range 20-28) were evaluated. Despite aggressive care (e.g., hemicraniectomy), 2 patients died owing to herniation, 1 patient died of cardiac causes, and neither of the 2 surviving patients achieved a 3-month Rankin score below 4 (moderately severe disability). Conclusions. Given the poor prognosis of patients with hemispheric stroke and early CT changes, alternative treatment modalities such as intra-arterial thrombolysis, early hemicraniectomy, and neuroprotective therapy should be vigorously pursued.
AB - Objectives. Whether acute stroke patients with major early infarct signs on computed tomography (CT) should be treated with intravenous (IV) thrombolysis remains controversial. The authors sought to define the outcomes in 5 consecutive patients who were not treated with IV thrombolysis, according to established guidelines. Methods. The authors retrospectively analyzed the outcomes of a consecutive series of 5 patients evaluated by an acute stroke team at a university medical center and who were denied IV tissue plasminogen activator due to early CT changes. Results. Five patients with a median National Institutes of Health Stroke Scale score of 22 (range 20-28) were evaluated. Despite aggressive care (e.g., hemicraniectomy), 2 patients died owing to herniation, 1 patient died of cardiac causes, and neither of the 2 surviving patients achieved a 3-month Rankin score below 4 (moderately severe disability). Conclusions. Given the poor prognosis of patients with hemispheric stroke and early CT changes, alternative treatment modalities such as intra-arterial thrombolysis, early hemicraniectomy, and neuroprotective therapy should be vigorously pursued.
KW - Acute ischemic stroke
KW - Cerebral infarction
KW - Computed tomography
KW - Hemicraniectomy
KW - Thrombolysis
KW - Tissue plasminogen activator
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UR - http://www.scopus.com/inward/citedby.url?scp=0035125566&partnerID=8YFLogxK
M3 - Article
VL - 11
SP - 40
EP - 43
JO - Journal of Neuroimaging
JF - Journal of Neuroimaging
SN - 1051-2284
IS - 1
ER -