Abstract Details

Title Back to the Basics: Neurologic Exam Trumps 24-Hour Follow-Up Computed Tomography Scans in Determining Symptomatic Intracerebral Hemorrhage

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S49 - (-)

Poster/Presentation
Number 004

Objective

Background Current research presents concerns surrounding subjecting patients to additional radiation through CT scans. We sought to determine if early neuro-deterioration (END) is a valid predictor of symptomatic intracerebral hemorrhage (sICH) in tPA treated patients.

Design/Methods Consecutive patients with AIS given tPA between June 2008 and December 2011 were retrospectively identified. Cases were excluded if intra-arterial treatment was received (n=15), a 24-hr CT was not performed (n=9), or 24-hr NIHSS score was not documented (n=6). The remaining cases were divided into: END (>/=2pt increase in NIHSS) and No END. Baseline characteristics and medical history, 24-hr CT scan findings, orders for new medical and/or surgical management within 6hrs of imaging, and administration of antithrombotics by 10 a.m. the following day were compared between the two groups.

Results Two-hundred cases met criteria: END n=26 and no END n=174. Abnormal CT findings were found more often among patients with END (88.5% vs. 59.2%, p=0.002). Of the 174 patients without END who were radiated for a 24-hour head CT 0 patients experienced sICH. The sensitivity of END predicting sICH was 100% with a specificity of 89%. The sensitivity of END predicting PH1/PH2 is 64% and the specificity is 90%.

Conclusions Given the low percentage of patients in our sample who did not experience END the utility of a 24 hour CT for diagnosing sICH is questionable. Given the recent concerns over negative side effects of widespread CT scans for diagnostic procedures, further studies are needed to investigate the risk/benefit of subjecting patients to radiation during a 24 hour CT as opposed to scanning only patients who experience 2 point neurological deterioration.

Authors/Disclosures
Amelia K. Boehme, PhD (Columbia University) PRESENTER	Dr. Boehme has nothing to disclose.
Frederik Barkhof, MD, PhD (Image Analysis Center)	Frederik Barkhof has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Frederik Barkhof has received personal compensation in the range of $0-$499 for serving as a Consultant for Biogen. Frederik Barkhof has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Combinostics. Frederik Barkhof has received personal compensation in the range of $500-$4,999 for serving as a Consultant for IXICO. Frederik Barkhof has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen. Frederik Barkhof has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EISAI.
Alexander George	No disclosure on file
Casey R. Dunn, MD (Washington University Department of Neurology)	No disclosure on file
Karen C. Albright, DO, DO, PhD, MS, MPH (FDA)	Dr. Albright has nothing to disclose.
James E. Siegler III, MD (University of Chicago)	Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Siegler has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bayer. Dr. Siegler has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Society of Vascular and Interventional Neurology. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke: Vascular and Interventional Neurology. Dr. Siegler has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for various medicolegal cases. The institution of Dr. Siegler has received research support from Philips. The institution of Dr. Siegler has received research support from Medtronic.
	No disclosure on file
	No disclosure on file
Sheryl Martin-Schild, MD, PhD, FAAN (Dr. Brain, Inc.)	No disclosure on file

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