Administrators, Editors, Administrators
3,484
edits
Changes
Jump to navigation
Jump to search
→Quantification of ischemic involvement - ASPECTS: Related to thrombolysis contraindications
At cut near top of the lateral ventricles: M4 - anterior third of cortex; M5 - middle third of
cortex; M6 - posterior third of cortex.<ref name=Mirza2016/>]]
A major reason for quantifying the volume in ischemic involvement is because extensive cerebral ischemia further increases the risk of secondary hemorrhage if thrombolysis is given.
Alberta Stroke Program Early CT score (ASPECTS) is a 10-point quantitative topographic CT
scan score developed in 2001 offering a reproducible grading system to score early ischemia inanterior circulation strokes to better direct treatment and reduce the variability of observations. Using two standard axial CT slices; one at the level of the thalamus and basal ganglia, andone just rostral to the basal ganglia, the MCA territory is divided into 10 regions,each accounting
for one point in the total score, for each involved area, a point is subtracted. This score correlated
inversely with the NIHSS (National Institutes of Health Stroke Score) with clinicians agreeing it
superior and more systematic compared to the conventional 1/3 MCA rule to exclude thrombolytic
treatment . The ASPECTS method is not without its limitations; such as difficulty in scoring
due to age related periventricular white matter changes or streak artifacts in the base of the skull
or tilt and motion artifacts. (ASPECTS diagram).<ref name=Mirza2016/> {|class="wikitable"|+ CT findings that generally contraindicate thrombolysis<ref name="FrankGrotta2013">{{cite journal|last1=Frank|first1=Benedikt|last2=Grotta|first2=James C.|last3=Alexandrov|first3=Andrei V.|last4=Bluhmki|first4=Erich|last5=Lyden|first5=Patrick|last6=Meretoja|first6=Atte|last7=Mishra|first7=Nishant K.|last8=Shuaib|first8=Ashfaq|last9=Wahlgren|first9=Nils G.|last10=Weimar|first10=Christian|last11=Lees|first11=Kennedy R.|title=Thrombolysis in Stroke Despite Contraindications or Warnings?|journal=Stroke|volume=44|issue=3|year=2013|pages=727–733|issn=0039-2499|doi=10.1161/STROKEAHA.112.674622}}</ref>|-| Edema, dense middle cerebral artery sign, loss of insular ribbon, lenticular hypodensity, acute infarction, sulcal effacement, or ASPECT-score of 8 or 9§|-| Mass effect, infarction of >1/3 of the middle cerebral artery territory, midline shift, or ASPECT-score of ≤7§|-| ASPECT-score of ≤7|}
==Computed tomography angiography (CTA)==
