Stroke For Discution
Stroke For Discution
thrombolytics or with other therapies will be Table-1: Sex and Age distribution in Patients of
determined by how accurately the diagnostic was Acute Stroke (n=120)
performed. An incorrect diagnosis, on the other hand, Characteristics of Patients
may result in patients being denied appropriate Gender of Patients Cases (N, %)
treatment or being exposed to potentially dangerous Male 84 (70%)
treatments without their knowledge [8]. The present Female 36 (30%)
study compared the clinical diagnosis with computed Age Group (In Year) Cases (N, %)
tomography to determine the specific type of acute 21-30 03 (2.5%)
stroke. 31-40 05 (4.16%)
41-50 12 (10%)
OBJECTIVE 51-60 37 (30.83%)
The main objective of this study was to 61-70 53 (44.16%)
compare clinical stroke diagnosis with computed 71-80 10 (8.33%)
tomography (CT) scan findings to determine stroke type Total 120 (100%)
(hemorrhagic or Ischemic).
The below table has shown that, most of the
patients (fifty-two, 43.33%) with acute stroke were
MATERIALS AND METHODS clinically diagnosed with infarction whereas thirty-eight
From January 2018 to December 2020, 120 patients (31.66%) were diagnosed with haemorrhage.
patients referred to Radiology departments at Medical Thirty patients (25%) were diagnosed with
College for Women and Hospital (MCWH), Uttara and indeterminate.
Catharsis Hospital in Pubail, Dhaka were included in
this cross-sectional and observational study. CT scans Table-2: Clinical diagnosis of the type of acute
of the brain were performed on all individuals with a stroke (n=120)
clinical diagnosis of the acute stroke where indicated, Diagnosis Cases (N, %)
clinical diagnosis, age, sex, the onset of symptoms, and
Haemorrhage 38 (31.66%)
time of hospitalization are included. Patients who
Infarction 52 (43.33%)
presented with a fast onset of coma, rapid deterioration
Indeterminate 30 (25%)
of neurological status, severe headache, severe
vomiting, neck stiffness, and hypertension were
diagnosed with hemorrhagic stroke. Patients presenting Table-3 has indicated that fifty-eight patients
with a sudden start of lateralizing size, particularly (48.33%) had infarction behind the acute stroke. Forty-
those with atrial fibrillation, rheumatic heart disease, two patients (35%) had a haemorrhage and fourteen
recent myocardial infarction, and carotid bruit, were patients (11.66%) had space-occupying lesions behind
deemed to have a cerebral infarction. Blood sugar, lipid the acute stroke. Only six patients (5%) had
profile, ECG, and echocardiography were all performed haemorrhage infarct. All of the patients with acute
in addition to the standard investigation. Every patient stroke in this table were diagnosed through a CT scan.
underwent a cerebral CT scan. Finally, the CT scan
findings and clinical diagnosis were compared Table-3: CT Scan findings in patients with acute
separately in order to ascertain the specific clinical stroke (n=120)
diagnosis. Diagnosis Cases (N, %)
Hemorrhage 42 (35%)
Infarction 58 (48.33%)
RESULTS Space Occupying Lesion 14 (11.66%)
Table-1 has shown that, eighty-four patients Hemorrhage Infarct 06 (5%)
(70%) of acute stroke among one hundred and twenty
were male and thirty-six patients (30%) were female. The below table has indicated that among
Most of the patients (fifty-three, 44.16%) were from the ninety patients thirty-eight had been clinically
age group 61-70. Thirty-seven patients (30.83%) were diagnosed with haemorrhage and among them, twenty-
from the age group 51-60. Twelve patients (10%) from one patients were diagnosed through CT scan where
41-50, ten (8.33%) from 71-80, five (4.16%) from 31- fifty-two patients had been diagnosed with infarction
40 and three (2.5%) were from age group 21-30 years. and among them, thirty patients were diagnosed with
CT scan.
The clinical diagnosis of the patients in this Ethiopia, Asefa et al., (2010) reported a
study was only 75% accurate when compared with the misinterpretation rate of 30% in relation to clinical
findings of the CT scan, which revealed a misdiagnosis diagnosis [10]. In a study of 156 Nigerian patients,
rate of 25%. This finding of the inadequacy of the Ogun et al., (2001) found 44% misinterpretation rate
clinical diagnosis is consistent with the findings of when comparing CT findings with clinical diagnosis
Salawu et al., (2009), who noted a misdiagnosis rate of [11].
15% when comparing clinical diagnosis with CT scans
in Maiduguri [9]. In a similar study conducted in
To assist physicians in making clinical 3. Sotaniemi, K. A., Pyhtinen, J., & Myllylä, V. V.
diagnoses, several scoring systems such as the "Allen (1990). Correlation of clinical and computed
score" and the "Siriraj score" have been invented to tomographic findings in stroke
assess the relative chance of infarction or haemorrhage. patients. Stroke, 21(11), 1562-1566.
While clinical diagnoses made with these scores appear 4. Weisberg, L. A. (1985). Nonseptic cardiogenic
to be more accurate than those made with a physician's cerebral embolic stroke: Clinical‐CT
clinical eye, they also introduced some complications. correlations. Neurology, 35(6), 896-896.
Thus, throughout the last decade, the "Allen score" 5. Houser, O. W., Campbell, J. K., Baker Jr, H. L., &
(also known as the Guy's Hospital score), a verified Sundt Jr, T. S. (1982). Radiologic evaluation of
clinical measure, acquired widespread support but has ischemic cerebrovascular syndromes with emphasis
since waned. In a study of 1059 patients in Glasgow, it on computed tomography. Radiologic Clinics of
was determined that the Guy's Hospital score had a North America, 20(1), 123-142.
sensitivity of 70% for diagnosing haemorrhage and a 6. Envision Radiology [Internet]. How CT scan and
specificity of 64% whereas the siriraj score had a MRI are used to diagnose strokes; [cited 2022
sensitivity of 68% and a specificity of 64%. This study February 12]. Available from:
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bleeding prior to initiating anticoagulant therapy [12]. to-diagnose-strokes/.
Badam et al., examined the Siriraj stroke score and 7. Kidwell, C. S., Chalela, J. A., Saver, J. L.,
Guy's Hospital score in an Indian environment [13]. Starkman, S., Hill, M. D., Demchuk, A. M., ... &
Both of the above-mentioned ratings were found to be Warach, S. (2004). Comparison of MRI and CT for
insufficient for conclusively identifying bleeding or detection of acute intracerebral
infarct in this investigation. hemorrhage. Jama, 292(15), 1823-1830.
8. Weir, C. J., Muir, K., Grosset, D. G., Lees, K. R.,
The outcomes of this study underscored the Murray, G. D., & Adams, F. G. (1994). Poor
critical nature of routine CT scans in acute stroke accuracy of stroke scoring systems for differential
patients, as they are widely available at all hours of the clinical diagnosis of intracranial haemorrhage and
day and night at large hospitals and produce images infarction. The Lancet, 344(8928), 999-1002.
fast. Additionally, CT scans offer distinct diagnostic 9. Salawu, F., Umar, I., & Danburam, A. (2009).
benefits since they rapidly rule out haemorrhages and Comparison of two hospital stroke scores with
can reveal even a small tumour that may mimic a computerized tomography in ascertaining stroke
stroke. type among Nigerians. Annals of African
Medicine, 8(1), 14.
10. Asefa, G., & Meseret, S. (2010). CT and clinical
CONCLUSION correlation of stroke diagnosis, pattern and clinical
While significant advances in stroke imaging outcome among stroke patients visting Tikur
have been made, including CT perfusion imaging, Anbessa Hospital. Ethiopian medical
Xenon CT, CT angiography, MR diffusion imaging, journal, 48(2), 117-122.
MR perfusion imaging, and MR angiography, the study 11. Ogun, A. S., Oluwole, S. O., Oluremi, A., Fatade,
discovered that clinical diagnosis of acute stroke alone A. O., Ojini, F., & Odusote, K. A. (2001).
is frequently insufficient, resulting in a high risk of poor Accuracy of the Siriraj stroke score in
patient morbidity. As a result, it is critical that CT be differentiating cerebral haemorrhage and infarction
used whenever possible in acute stroke therapy. in African Nigerians. African Journal of
Neurological Sciences, 20(1).
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Cite This Article: Rosy Perveen, Habibur Rahman, AFMS Islam, Ruksana P. Khan (2023). Computed Tomography Findings in Acute
Stroke Patients: A Hospital-Based Cross-Sectional Study. EAS J Radiol Imaging Technol, 5(1), 33-36.