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Evaluation of acute cerebral ischemia for anticoagulant therapy

Computed tomography or lumbar puncture

From the Research Center in Cerebrovascular Disease, Department of Neurology, the New York Hospital, Cornell Medical Center, New York, NY.

Of 217 patients with clinical diagnosis of acute stroke 23% had nonischemic lesions diagnosed by computed tomography (CT) or lumbar puncture (LP). CT demonstrated all 37 cases of intracerebral hemorrhagic lesions; 9 were detected by LP. CT failed to demonstrate 8 of 17 cases of subarachnoid hemorrhage, but only 1 of these lacked headache or stiff neck.

In 7 of 342 patients who were treated with anticoagulants after LP, spinal hematoma followed LP (5 with paraparesis). CT evaluation reduced the incidence of fatal cerebral hemorrhage during anticoagulant therapy of acute stroke. However, even if patients were evaluated with both CT and LP, the incidence of fatal cerebral hemorrhage resulting from intravenous anticoagulant therapy was 2.4%.

Address correspondence and reprint requests to Dr. Ruff, Division of Neurology RG-20, University of Washington, Seattle, WA 98195.

This work was supported by NINCDS Teacher-Investigator Award No. NS 00498 (Dr. Rum and NIH Grant No. NS-03346 and NIH Fellowship No. IF32 NS-06069 (Dr. Dougherty).

Accepted for publication September 29, 1980.

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