• N Joshi, S Chaturvedi, and W M Coplin.
• WSU/DMC Stroke Program and Department of Neurology, Wayne State University/Detroit Medical Center, 8C-UHC, 4201 St. Antoine, Detroit, MI 48201, USA.
• J Neuroimaging. 2001 Jan 1; 11 (1): 40-3.

ObjectivesWhether acute stroke patients with major early infarct signs on computed tomography (CT) should be treated with intravenous (i.v.) thrombolysis remains controversial. The authors sought to define the outcomes in 5 consecutive patients who were not treated with i.v. thrombolysis, according to established guidelines.MethodsThe authors retrospectively analyzed the outcomes of a consecutive series of 5 patients evaluated by an acute stroke team at a university medical center and who were denied i.v. tissue plasminogen activator due to early CT changes.ResultsFive patients with a median National Institutes of Health Stroke Scale score of 22 (range 20-28) were evaluated. Despite aggressive care (e.g., hemicraniectomy), 2 patients died owing to herniation, 1 patient died of cardiac causes, and neither of the 2 surviving patients achieved a 3-month Rankin score below 4 (moderately severe disability).ConclusionsGiven the poor prognosis of patients with hemispheric stroke and early CT changes, alternative treatment modalities such as intra-arterial thrombolysis, early hemicraniectomy, and neuroprotective therapy should be vigorously pursued.

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