Correlation of clinical and computed tomographic findings in stroke patients

Abstract

We evaluated the correlation between clinical features and computed tomographic findings in a prospective study of 1,191 consecutive patients with acute cerebrovascular disease seen during 1 year. In the 386 patients in whom symptoms and signs initially suggested a cerebrovascular disorder, computed tomography revealed a relevant lesion in 154 (hemorrhagic in 52 [33.8%], ischemic in 102 [66.2%]) and a significant nonstroke abnormality in 14 (3.1%). Among the remaining 805 patients with symptoms and signs suggesting some central nervous system disorder other than stroke, computed tomography revealed a cerebrovascular lesion in 38 (4.7%); 35 of these lesions were ischemic. The computed tomographic findings was compatible with the final clinical diagnosis in 192 (84.2%) of the 228 patients with lesions. In the entire sample of 1,191 patients, a cerebrovascular disorder would have been missed in 38 (3.2%) without computed tomography. On the other hand, computed tomography failed to visualize a cerebrovascular lesion in 40 patients in whom such a lesion was clinically obvious. Our results emphasize that both careful neurologic assessment and a policy of early computed tomography are of crucial importance in the diagnosis of stroke and for therapeutic considerations.