Publication: Post rtPA CT brain may not be mandatory in all stroke patients when resources are limited
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Issued Date
2013-03-01
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ISSN
18726968
03038467
03038467
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2-s2.0-84873715737
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Mahidol University
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SCOPUS
Bibliographic Citation
Clinical Neurology and Neurosurgery. Vol.115, No.3 (2013), 285-288
Suggested Citation
Pornpatr A. Dharmasaroja, Sombat Muengtaweepongsa, Permphan Dharmasaroja Post rtPA CT brain may not be mandatory in all stroke patients when resources are limited. Clinical Neurology and Neurosurgery. Vol.115, No.3 (2013), 285-288. doi:10.1016/j.clineuro.2012.05.040 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/32458
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Title
Post rtPA CT brain may not be mandatory in all stroke patients when resources are limited
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Abstract
Background: Routine neuroimaging of the brain is performed after recombinant-tissue-plasminogen activator (rtPA) treatment in patients with acute ischemic stroke. However, in situation where resources are limited, it is not known if a follow-up computed tomography (CT) is beneficial for guiding the treatment plan or not. The purpose of this study is to investigate the need for a follow-up CT in patients with acute stroke after rtPA treatment. Methods: Patients who were treated with intravenous rtPA were included. Clinical symptoms/signs of the patients were evaluated at 24 h after rtPA treatment compared with baseline NIHSS. The need for a follow-up CT after rtPA treatment was assessed by comparison of the early clinical changes with the CT brain results that would affect the management plan: presence of hemorrhagic transformation, malignant MCA infarction, or large cerebellar infarction. Results: 200 patients were included. 19 patients (9.5%) had complete recovery. CT post rtPA revealed no change in these patients. In 105 patients who had early improvement with NIHSS of 1-10 at 24 h, follow-up CT findings did not change the plan of management in 85%. Follow-up CTs may help in planning further management in 65% and 67% of the patients who had NIHSS > 10 at 24 h and early worsening, respectively. Conclusions: CT post rtPA may not be required in patients with early clinical recovery (NIHSS = 0). However, in patients with residual severe deficit post rtPA or patients with early worsening or suspected posterior circulation stroke, CT post rtPA is still needed. © 2012 Elsevier B.V.