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P173 Aims Recent thrombolytic trials in acute stroke,  and acute treatment in the USA, exclude patients with early CT changes  of infarction affecting greater than one third of the middle cerebral  artery (MCA) territory because of a possible increased risk of  parenchymal haemorrhage. We reviewed CT scans of patients recruited  into the Australian Streptokinase Trial to determine whether such  changes or other factors were predictive in this group of patients.  Methodology Acute CT scans were classified by three  neurology research fellows according to ECASS criteria in 264 patients.  Where consensus was not reached, a panel of ECASS trained physicians  reviewed the scans. Haemorrhage on second CT were classified into  haemorrhagic infarction or parenchymal haemorrhage. Results CT s showed  no acute changes in 36%, minor ischaemic changes ( 1/3 MCA territory) in 35%.  Major early ischaemic changes were predictive of haemorrhagic  infarction (p=0.037) and stroke death (p= &lt;0.001). Major changes were  not predictive of parenchymal haemorrhage (O.R.=0.70 95% C.I.= 0.30 -  1.66). Parenchymal haemorrhage was not more likely with any early CT  changes or delays in time to therapy but was predictive of death and  severe disability. Systolic blood pressure prior to treatment was  significantly higher in patient s with secondary parenchymal  haemorrhage(p = 0.03). Discussion Early CT changes were  predictive of poor outcome but not predictive of parenchymal  haemorrhage. The risk of parenchymal haemorrage was increased with  moderately increased systolic blood pressure. Excluding patients with  high risk of parenchymal haemorrhage, may improve the safety and  overall efficacy of thrombolytic therapy. The findings of this study do  not support the exclusion of patients on CT criteria.

Early CT Changes Do Not Predict Parenchymal Haemorrhage Following Streptokinase Therapy In Acute Stroke.