Computed tomography-based mathematical modeling of ischemic stroke outcomes based on the focus characteristics

Abstract

Objective: to identify the prognostic aspects of the ischemic stroke (IS) focus characteristics according to the data of computed tomography of the brain.Patients and methods. We examined 80 patients with hemispheric IS up to 1-day old (50 patients for constructing mathematical models of disease outcomes and 30 patients for subsequent testing of the obtained models) aged 30-84 years.Results and discussion. The analysis of the association between mortality probability and brain midline shift size shown that a brain midline shift of 4.5-5 mm did not increase mortality probability much, which indicates the synergistic stability of this system. System destabilization began after an increase of the brain midline shift for more than 5-5.5 mm. After a mild change in the initial indicator (6-8 mm), mortality probability increased from 25% to 90% and higher. When the brain midline shift was more than 8.5 mm, the system, from the synergistic viewpoint, became stable again but with an unfavorable prognosis. This analysis helps to identify the critical decision-making point when analyzing the IS focus neuroimaging characteristics. Thus, the point for the focus volume is 145 cm3, and for the brain midline shift - 5.0 mm.Conclusion. The results of our study about the prognostic value of the IS focus characteristics according to CT data may have additional value for decision-making in the management of patients with a poor prognosis.

Keywords

• ischemic stroke
• computed tomography
• prognosis