Computed Tomographic-Angiographic Findings Within the First Five Hours of Cerebral Infarction

Background and Purpose: Modern management of acute stroke necessitates early diagnosis. To this end, we sought to delineate the radiographic features of focal hemispheric infarction within 5 hours of ictus. Methods: Fifty patients, ages 54-79, with ischemic strokes productive of at least hemiparesis underwent computed tomographic scanning and cerebral angiography (n=38) or carotid ultra-sound (n=12). Radiographic lesions were characterized for location, size, and pathophysiology. Results: Acute abnormalities, hypodensity, and mass effect were seen in 56 % of scans and confirmed on a second scan 5-7 days later. Intracranial angiographic abnormalities occurred in 61 % of patients: arterial occlusions in 45 % and delayed arterial filling in 16%. Hemorrhagic infarctions occurred in 26 % of second scans and were associated with mass effect (100%) and arterial occlusions (89%). Infarcts with hemorrhagic transformation were larger on both scans than those without (p=0.001). Of four patients with infarctions in watershed territories on the scans, two had middle cerebral artery occlusions on angiography, thereby questioning the specificity of such scan lesions to low-flow states. Conclusions: We conclude that cerebral infarctions are often visible on early scans, but thei