Background: Patients who suffer from acute stroke should be examined with computed tomography (CT) of the brain immediately after admission. If evaluated systematically, this examination may give more information than just "bleeding excluded".
Material and methods: CT scans of the brain in four patients with acute ischaemic stroke admitted to our department illustrate the typical early CT signs in acute cerebral ischaemia.
Results: This article describes the systematic evaluation of a CT in acute stroke, when the following questions need to be answered: Is there a hyperdense middle cerebral artery sign (HMCAS), or hypodensity in other major intracranial arteries? Is there a hypodensity in the basal ganglia? Is there hypodensity (loss of cortical-subcortical discrimination) or oedema (decreasing volume of the Sylvian fissure) in the insular region? Is there hypodensity (loss of cortical-subcortical discrimination) or oedema (effacement of sulci or compression of ventricles) in other parts of the distribution of the middle cerebral artery or other arteries?
Interpretation: An early CT in acute stroke patients may yield valuable information if evaluated properly. The presence or absence of early CT sign have implications for diagnosis, prognosis, choice of supplementary examinations, and choice of treatment.