Prevalence and significance of hyperdense middle cerebral artery in acute stroke. D Leys, J P Pruvo, O Godefroy, P Rondepierre and X Leclerc Stroke. 1992;23:317-324 doi: 10.1161/01.STR.23.3.317 Stroke is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 1992 American Heart Association, Inc. All rights reserved. Print ISSN: 0039-2499. Online ISSN: 1524-4628
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://stroke.ahajournals.org/content/23/3/317
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Original Contributions Prevalence and Significance of Hyperdense Middle Cerebral Artery in Acute Stroke D. Leys, MD; J.P. Pruvo, MD; O. Godefroy, MD; Ph. Rondepierre, MD; and X. Leclerc, MD Background and Purpose: Early noncontrast computed tomographic scans may visualize a hyperdense middle cerebral artery before the infarct becomes visible. This sign disappears within a few days, corresponds to the clot itself, and might be associated with a poor prognosis. The aim of the study was to determine its prevalence, diagnostic value, relationship to demographic data, ability to separate embolic from nonembolic causes, short-term prognostic value, evolution over time, and relationship to arterial occlusion on angiography. Methods: We performed this study using computed tomographic scans performed within 12 hours after onset in 272 consecutive unselected patients with a first acute cerebrovascular event. Results: Seventy-three subjects had the hyperdense middle cerebral artery sign, leading to a prevalence of 26.8% in the whole group and 41.2% in patients with a middle cerebral artery infarct. Specificity was 100%, but sensitivity was only 30%. This sign was not dependent on cerebrovascular risk factors, but was more likely to occur in cortical and in large, deep, middle cerebral artery infarcts (p12 hours after onset or unknown time of onset Alzheimer's disease Progressive stroke
52 1 9 3 2 87 8 13
Four patients had two exclusion criteria.
ing to the 0-3-point subtest of the Modified National Institute of Health Stroke Scale15; intensity of the neurological deficit, using a 0-100-point rating scale16; presence of hypertension (Inzitari's criteria17), diabetes mellitus and cardiovascular disorders (Leys' criteria18), elevated blood triglycerides (fasting serum level >2.5 g/1), elevated blood cholesterol (fasting serum level >2.5 g/1), coagulopathy (prothrombin time
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://stroke.ahajournals.org/content/23/3/317
Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Stroke can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Stroke is online at: http://stroke.ahajournals.org//subscriptions/
Downloaded from http://stroke.ahajournals.org/ by guest on April 5, 2014
317
Original Contributions Prevalence and Significance of Hyperdense Middle Cerebral Artery in Acute Stroke D. Leys, MD; J.P. Pruvo, MD; O. Godefroy, MD; Ph. Rondepierre, MD; and X. Leclerc, MD Background and Purpose: Early noncontrast computed tomographic scans may visualize a hyperdense middle cerebral artery before the infarct becomes visible. This sign disappears within a few days, corresponds to the clot itself, and might be associated with a poor prognosis. The aim of the study was to determine its prevalence, diagnostic value, relationship to demographic data, ability to separate embolic from nonembolic causes, short-term prognostic value, evolution over time, and relationship to arterial occlusion on angiography. Methods: We performed this study using computed tomographic scans performed within 12 hours after onset in 272 consecutive unselected patients with a first acute cerebrovascular event. Results: Seventy-three subjects had the hyperdense middle cerebral artery sign, leading to a prevalence of 26.8% in the whole group and 41.2% in patients with a middle cerebral artery infarct. Specificity was 100%, but sensitivity was only 30%. This sign was not dependent on cerebrovascular risk factors, but was more likely to occur in cortical and in large, deep, middle cerebral artery infarcts (p12 hours after onset or unknown time of onset Alzheimer's disease Progressive stroke
52 1 9 3 2 87 8 13
Four patients had two exclusion criteria.
ing to the 0-3-point subtest of the Modified National Institute of Health Stroke Scale15; intensity of the neurological deficit, using a 0-100-point rating scale16; presence of hypertension (Inzitari's criteria17), diabetes mellitus and cardiovascular disorders (Leys' criteria18), elevated blood triglycerides (fasting serum level >2.5 g/1), elevated blood cholesterol (fasting serum level >2.5 g/1), coagulopathy (prothrombin time
