OBJECTIVE:To evaluate whether findings on computed tomography (CT) are useful to predict early mortality after acute cerebral infarction. METHODS: An admission CT was performed in 98 patients with disease-onset within 7 days; CT findings were analyzed using a checking list; their influence on hospital mortality was studied by logistic regression analysis. RESULTS: There were 29 hospital deaths. Uncal herniation and midline shift>4mm were strongly correlated with fatal outcome. Also associated with increased mortality: infarction of a whole hemisphere or in the distribution of internal carotid artery; massive (>90% expected area) infarction in the territory of the anterior or posterior cerebral arteries; massive or submassive (>50% expected area) middle cerebral artery infarction; large lesion volume (death in 9/13 patients with lesions >50cm³); any degree of mass effect. In 68 patients with single middle cerebral artery lesions, extension of the lesion to adjacent vascular territories was also associated with a worse outcome. The number of lesions and the presence of contrast enhancement, hemorrhagic changes or cerebral atrophy did not influence outcome. CONCLUSIONS: CT findings indicating significant mass effect and large infarcts are associated with mortality after ischemic stroke. The best combination of clinical and CT variables to estimate death risk in individual patients remains to be determined.
cerebral infarction; cerebrovascular disorders; cerebral hernia; mortality; prognosis; CT scan