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

To assess the prognostic value of computed tomography (CT) in hyperacute middle cerebral artery (MCA) infarcts. 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. 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. Computed tomography features and the admission NIHSS score are important predictors of survival in hyperacute extensive MCA infarcts.