Early computed tomography hypodensity predicts hemorrhage after intravenous tissue plasminogen activator in acute ischemic stroke

被引:37
作者
Dubey, N
Bakshi, R
Wasay, M
Dmochowski, J
机构
[1] Kaleida Hlth, Imaging Serv, Buffalo, NY USA
[2] SUNY Buffalo, Dept Neurol, Buffalo, NY 14260 USA
[3] Univ Texas, Hlth Sci Ctr, Dept Neurol, Houston, TX 77225 USA
[4] Aga Khan Univ, Dept Neurol, Karachi 74800, Pakistan
[5] SUNY Buffalo, Dept Social & Prevent Med, Div Biostat & Med Informat, Buffalo, NY 14260 USA
关键词
computed tomography; thrombolysis; basal ganglia; ischemic stroke; hemorrhage;
D O I
10.1111/j.1552-6569.2001.tb00031.x
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Parenchymal hypodensity is a proposed risk factor for hemorrhage after recombinant tissue plasminogen activator (TPA) thrombolysis for ischemic stroke. In Buffalo, NY, and Houston, TX, the authors reviewed 70 patients who were treated with intravenous TPA for acute middle cerebral artery (MCA) stroke. Two observers blinded to clinical outcome analyzed initial noncontrast head computed tomography (CT) scans. Basal ganglia CT hypodensity was quantitated in Hounsfield units (HUs). Contralateral-ipsilateral difference in density was calculated using the asymptomatic side as a control. Ictus time to TPA averaged 2.5 hours. Six patients developed symptomatic intraparenchymal hematomas (2 fatal). The hemorrhage group had more severe basal ganglia hypodensity (mean 7.5 +/- 1.4, range 6-10 HU) than the nonhemorrhage group (2.2 +/- 1.4, range 0-9 HU) (P < .0001). The hemorrhage group had hypodensity of >5 HU; the nonhemorrhage group had hypodensity of less than or equal to4 HU, except 1 patient with hypodensity of 9 HU. In predicting hemorrhage, the positive predictive value of hypodensity > 5 HU was 86%; the negative predictive value was 100%. Prethrombolysis NIH Stroke Scale (NIHSS) deficit (P = .0007) and blood glucose (P = .005) were also higher in the hemorrhage group. Age, gender, smoking, hypertension, and ictus time to TPA infusion did not differ between the 2 groups. Logistic regression indicated that basal ganglia hypodensity was the best single predictor of hemorrhage. Hypodensity and NIHSS score together predicted all cases of hemorrhage. The authors conclude that basal ganglia hypodensity quantified by CT may be a useful method of risk stratification to select acute MCA stroke patients for thrombolytic therapy.
引用
收藏
页码:184 / 188
页数:5
相关论文
共 12 条
[1]  
Bakshi R, 1999, AM J NEURORADIOL, V20, P629
[2]   Acute middle cerebral artery thrombosis demonstrated by cranial computed tomography -: The "dense MCA" sign [J].
Bakshi, R .
ARCHIVES OF NEUROLOGY, 1998, 55 (12) :1577-1577
[3]   Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke [J].
Brott, T ;
Broderick, J ;
Kothari, R ;
ODonoghue, M ;
Barsan, W ;
Tomsick, T ;
Spilker, J ;
Miller, R ;
Sauerbeck, L ;
Farrell, J ;
Kelly, J ;
Perkins, T ;
Miller, R ;
McDonald, T ;
Rorick, M ;
Hickey, C ;
Armitage, J ;
Perry, C ;
Thalinger, K ;
Rhude, R ;
Schill, J ;
Becker, PS ;
Heath, RS ;
Adams, D ;
Reed, R ;
Klei, M ;
Hughes, A ;
Anthony, J ;
Baudendistel, D ;
Zadicoff, C ;
Rymer, M ;
Bettinger, I ;
Laubinger, P ;
Schmerler, M ;
Meiros, G ;
Lyden, P ;
Dunford, J ;
Zivin, J ;
Rapp, K ;
Babcock, T ;
Daum, P ;
Persona, D ;
Brody, M ;
Jackson, C ;
Lewis, S ;
Liss, J ;
Mahdavi, Z ;
Rothrock, J ;
Tom, T ;
Zweifler, R .
STROKE, 1997, 28 (11) :2109-2118
[4]   Neurological deterioration in acute ischemic stroke -: Potential predictors and associated factors in the European Cooperative Acute Stroke Study (ECASS) I [J].
Dávalos, A ;
Toni, D ;
Iweins, F ;
Lesaffre, E ;
Bastianello, S ;
Castillo, J .
STROKE, 1999, 30 (12) :2631-2636
[5]   RECOMBINANT TISSUE PLASMINOGEN-ACTIVATOR IN ACUTE THROMBOTIC AND EMBOLIC STROKE [J].
DELZOPPO, GJ ;
POECK, K ;
PESSIN, MS ;
WOLPERT, SM ;
FURLAN, AJ ;
FERBERT, A ;
ALBERTS, MJ ;
ZIVIN, JA ;
WECHSLER, L ;
BUSSE, O ;
GREENLEE, R ;
BRASS, L ;
MOHR, JP ;
FELDMANN, E ;
HACKE, W ;
KASE, CS ;
BILLER, J ;
GRESS, D ;
OTIS, SM .
ANNALS OF NEUROLOGY, 1992, 32 (01) :78-86
[6]   Serum glucose level and diabetes predict tissue plasminogen activator-related intracerebral hemorrhage in acute ischemic stroke [J].
Demchuk, AM ;
Morgenstern, LB ;
Krieger, DW ;
Chi, TL ;
Hu, W ;
Wein, TH ;
Hardy, RJ ;
Grotta, JC ;
Buchan, AM .
STROKE, 1999, 30 (01) :34-39
[7]   Agreement and variability in the interpretation of early CT changes in stroke patients qualifying for intravenous rtPA therapy [J].
Grotta, JC ;
Chin, D ;
Lu, M ;
Patel, S ;
Levine, SR ;
Tilley, BC ;
Brott, TG ;
Haley, EC ;
Lyden, PD ;
Kothari, R ;
Frankel, M ;
Lewandowski, CA ;
Libman, R ;
Kwiatkowski, T ;
Broderick, JP ;
Marler, JR ;
Corrigan, J ;
Huff, S ;
Mitsias, P ;
Talati, S ;
Tanne, D .
STROKE, 1999, 30 (08) :1528-1533
[8]  
HACKE W, 1995, JAMA-J AM MED ASSOC, V274, P1017, DOI 10.1001/jama.274.13.1017
[9]   Evaluation of early computed tomographic findings in acute ischemic stroke [J].
Marks, MP ;
Holmgren, EB ;
Fox, AJ ;
Patel, S ;
von Kummer, R ;
Froehlich, J .
STROKE, 1999, 30 (02) :389-392
[10]   TISSUE-PLASMINOGEN ACTIVATOR FOR ACUTE ISCHEMIC STROKE [J].
MARLER, JR ;
BROTT, T ;
BRODERICK, J ;
KOTHARI, R ;
ODONOGHUE, M ;
BARSAN, W ;
TOMSICK, T ;
SPILKER, J ;
MILLER, R ;
SAUERBECK, L ;
JARRELL, J ;
KELLY, J ;
PERKINS, T ;
MCDONALD, T ;
RORICK, M ;
HICKEY, C ;
ARMITAGE, J ;
PERRY, C ;
THALINGER, K ;
RHUDE, R ;
SCHILL, J ;
BECKER, PS ;
HEATH, RS ;
ADAMS, D ;
REED, R ;
KLEI, M ;
HUGHES, S ;
ANTHONY, J ;
BAUDENDISTEL, D ;
ZADICOFF, C ;
RYMER, M ;
BETTINGER, I ;
LAUBINGER, P ;
SCHMERLER, M ;
MEIROSE, G ;
LYDEN, P ;
RAPP, K ;
BABCOCK, T ;
DAUM, P ;
PERSONA, D ;
BRODY, M ;
JACKSON, C ;
LEWIS, S ;
LISS, J ;
MAHDAVI, Z ;
ROTHROCK, J ;
TOM, T ;
ZWEIFLER, R ;
DUNFORD, J ;
ZIVIN, J .
NEW ENGLAND JOURNAL OF MEDICINE, 1995, 333 (24) :1581-1587