Characteristics of CT Findings in Patients of Acute Stroke and Their Relationship to Mortality

Abstract

Stroke is one of the leading causes of death after heart disease and cancer in the developed countries and one of the leading causes of death in Bangladesh. The aim of this study was to assess the CT findings of acute stroke patients and their relationship with mortality. This study also evaluates the risk factors of stroke and thus help in awareness building in reducing stroke. This study will provide a basis for statistical studies on the prognostic factors of intracerebral haemorrhage / infarct for future studies. In the present study, a total number of 321 CT diagnosis stroke patients were selected from different clinics of Rajshahi and the department of Radiology and Imaging, Rajshahi Medical College, Rajshahi, Bangladesh in collaboration with department of Neuromedicine of Rajshahi Medical College, Rajshahi from January 2012 to December 2015. Diverse clinical presentation of stroke, presence of various risk factors, CT findings, type of stroke and correlation between Computed Tomography Scan findings with mortality within 7 days & 28 days were studied. The main objective of this study was to correlate the CT findings of acute stroke and their correlation with mortality. The result of this study was compared with the results of similar kind of studies carried out both at home and abroad. CT provides an excellent imaging modality for early detection of infarct which helps to improve patient management. In the present study, an analysis of 321 patients with spontaneous intracranial hemorrhage and ischaemic stroke was done. This study concluded the following aspects: Incidence of non traumatic spontaneous intracranial hemorrhage and ischaemic stroke was highest around 61 to 70 years of age. Sex incidence of stroke was high in male and male to female ratio was 60.12:39.88. Hypertension was the major causative factor for stroke and it was in 225(70.09%) patients. Intraparenchymal hemorrhage was the commonest variety of non traumatic spontaneous intracranial hemorrhage i.e. more than five times of subarachnoid hemorrhage. Basal ganglia were the commonest location of intraparenchymal hemorrhage. Among the patients with intraparenchymal hemorrhage, 44.44% patient died within 28 days. The predominant neurological defect was hemiparesis/hemiplegia (91.3%) which was found among 66(91.7%) of CT diagnosed ischemic cases and 28(90.3%) haemorrhagic cases. Headache and neck rigidity were more commonly associated with haemorrhagic stroke. Primary intracerebral haemorrhage was detected in 99(88.39%) cases and subarachnoid haemorrhage in 13 (11.61%) cases. The commonest site 62(29.67%) of infraction was basal ganglia and paraventricular region followed by parietal region 55(26.32%). Middle cerebral artery was involved in 159(76.08%) of cases of infarct. CT scan detected infarcts < 2 cm in 78(37.32%), 2-5 cm in 106(50.72%) and >5 cm in 25(11.96%) patients. Mass effect was found more in haemorrhagic stroke than in ischaemic stroke. The significant predictors of 28 days mortality were intraventricular hemorrhage, midline shift, hydrocephalus, subarachnoid extension of bleed and volume of hematoma 61 ml and above and infarct diameter.