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Poor Prognosis of Acute Stroke Patients Denied Thrombolysis Due to Early CT Findings
Author(s) -
Joshi Nishith,
Chaturvedi Seemant,
Coplin William M.
Publication year - 2001
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/j.1552-6569.2001.tb00007.x
Subject(s) - medicine , thrombolysis , acute stroke , modified rankin scale , stroke (engine) , computed tomography , brain herniation , radiology , tissue plasminogen activator , ischemia , ischemic stroke , myocardial infarction , mechanical engineering , engineering
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.