Early signs of
brain infarction can be detected by modern CCT technology even within the first 6 h after
stroke. Little is known about the prognostic significance of early
infarction signs in CCT. We prospectively evaluated clinical and CCT findings of 95 consecutive patients with an acute
ischemia in the territory of the middle cerebral artery. All patients were admitted to our
stroke unit within 6 h after
stroke. In 55 patients CCT was performed within 3 h, and in 40 cases between 3 and 6 h. In all patients the clinical findings were assessed by the Scandinavian
Stroke Scale (SSS). The disability due to
stroke was evaluated after 4 weeks by use of the modified Rankin Scale. We could demonstrate the following early signs of
cerebral infarction: focal hypodensity (23.2%), obscuration of basal ganglia (12.6%), focal
brain swelling (22.1%), hyperdense middle cerebral artery sign (
HMCA; 11.5%). In 3 patients early
edema led to ventricular compression, in 1 patient to midline shift. The occurrence of early
infarction signs did not depend on the etiology of
ischemia but was significantly associated with a severe neurological deficit at admission and an unfavourable disability status 4 weeks after
stroke. Focal
brain swelling and
HMCA were often followed by extensive
infarction lesions on the follow-up CCT. In conclusion, early signs of hemispheric
brain infarction visible on CCT scans performed within 6 h after
stroke are correlated with severe
stroke and an unfavourable functional outcome. However, a substantial part of our patients had a benign course of the disease in spite of early CCT pathology. Decisions on
therapy in individual patients therefore should not depend on early CCT findings exclusively.