Hyperacute extensive middle cerebral artery territory infarcts. Role of computed tomography in predicting outcome.

Objective: To assess the prognostic value of computed tomography (CT) in hyperacute middle cerebral artery (MCA) infarcts.
Methods: The CT features, total CT score, and National Institutes of Health Stroke Scale (NIHSS) score were correlated with the 30-day mortality in 16 patients with a hyperacute MCA infarct.
Results: Admission NIHSS scores were significantly lower in the survival group (P = 0.016). The extent of infarct, attenuation of corticomedullary differentiation, and total CT score were associated with 30-day mortality (P < 0.05). In prediction of mortality, extent of an infarct > 67% gave sensitivity, specificity, positive predictive value, and negative predictive value rates of 86%, 100%, 100%, and 90%, respectively. Attenuation of corticomedullary differentiation gave sensitivity, specificity, positive predictive value, and negative predictive value rates of 86%, 89%, 86%, and 89%, respectively. An NIHSS score > 28 gave sensitivity, specificity, positive predictive value, and negative predictive value rates of 86%, 67%, 67%, and 86%, respectively. A CT score > 4 gave sensitivity, specificity, positive predictive value, and negative predictive value rates of 86%, 78%, 75%, and 88%, respectively.
Conclusions: Computed tomography features and the admission NIHSS score are important predictors of survival in hyperacute extensive MCA infarcts.