Pathophysiology of acute middle cerebral artery infarct by multimodal computed tomography: A pilot study in Thai patients

AIMS: The purpose of this study was to study pathophysiology of acute middle cerebral artery infarct using multimodal CT and to evaluate the safety and feasibility of this method in our center. MATERIALS AND METHODS: Patients who had moderate to severe stroke (NIHSS score > 10), suspected of anterior circulation infarct and presented within 4 hours after stroke onset were prospectively included. Multimodal CTs, using low-osmolar contrast agents, were performed in all patients. RESULTS: Twenty-two patients were included. Mean NIHSS was 16. All patients received intravenous thrombolysis. Favorable outcome was found in nine patients (41%). CTP was unable to identify ischemic lesions in three patients with small subcortical infarct. Most patients (82%) with large middle cerebral artery infarct still had some salvageable brain (penumbra) which partly recovered in a follow-up imaging. Eleven patients (50%) had major artery occlusion. Two patients had creatinine rising within 72 hours. CONCLUSIONS: Multimodal CT does provide information about status of major artery and the volume of salvageable/infarct brain tissue and is safely and easily applicable in our center.