Computed Tomography Findings of the Brain in Stroke Fast Track at Thabo Crown Prince Hospital (Pre and Post Thrombolytic Therapy)

Abstract

Background: The incidence of strokes in Thailand has been increasing annually. The stroke fast track network aims to promptly provide intravenous thrombolytic drugs to acute ischemic stroke patients. Objective: To analyze the demographics, clinical presentations, and computed tomography (CT) findings of the brain (pre- and post-thrombolytic therapy) of stroke fast track patients at Thabo Crown Hospital. Method: This retrospective descriptive study was conducted from July 1, 2019, to December 31, 2021. The data were analyzed by descriptive statistics, i.e., percentage and frequency. Result: A total of 52 stroke fast track patients diagnosed with acute ischemic stroke and who underwent intravenous thrombolytic therapy were recruited. The majority sex was male (54%) and 71-90 years old (36.5%). The most frequent clinical presentations were 48.1% of right hemiparesis, followed by left hemiparesis, dysarthria or aphasia, facial palsy, and paresthesia, respectively. The first abnormal CT scan findings (pre-thrombolytic therapy) were obscuration of the lentiform nucleus, loss of the insular ribbon, parenchymal hypodensity, and hyperdense middle cerebral artery, respectively, the same as the second abnormal (post-thrombolytic therapy) findings with 11.5% hemorrhagic transformation. The six patients were normal first CT scan findings (pre-thrombolytic therapy). In contrast, parenchymal hypodensity, followed by obscuration of the lentiform nucleus and hemispheric sulcal effacement, respectively, were found in the second CT scan. Conclusion: The earliest CT finding of stroke fast track patients (pre- and post-thrombolytic therapy) found from this study is obscuration of the lentiform nucleus. At the same time, patients with no abnormal findings on the first CT scan are mostly found with parenchymal hypodensity on the post-thrombolytic CT scan (24 hours later).