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Case Report and Implications for Management

Andreja S. Packard, MD, PhD; Carlos S. Kase, MD; Ahmed S. Aly, MD; Glenn D. Barest, MD

Arch Neurol. 2003;60:1156-1159.

Background  Noncontrast computed tomographic (CT) scanning of the brain is the main imaging modality recommended for the initial emergency evaluation of acute stroke. The main role of CT in this setting is to rule out intracerebral hemorrhage, especially in subjects who are potential candidates for thrombolytic therapy.

Objectives and Results  We studied a patient who had symptoms suggestive of a transient ischemic attack. Although serial CT scans showed no evidence of hemorrhage, a subacute intracerebral hemorrhage was demonstrated by magnetic resonance imaging.

Conclusions  This case suggests that an alternative to CT scanning should be considered in patients with acute stroke to lower the risk of an undetected intracerebral hemorrhage, especially in patients being considered for thrombolytic or anticoagulant therapy. There is evidence in the literature of other "CT-negative" cases of intracerebral hemorrhage, as well as the availability of alternative imaging techniques such as gradient echo ("susceptibility-weighted") magnetic resonance imaging sequences, which can enhance the ability of magnetic resonance imaging to detect an acute intracerebral hemorrhage.

From the Departments of Neurology (Drs Packard, Kase, and Aly) and Neuroradiology (Dr Barest), Boston Medical Center, Boston, Mass.

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