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CT Density Changes with Rapid Onset Acute, Severe, Focal Cerebral Ischemia in Monkeys

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Abstract

Computerized tomography (CT) is the most often used imaging modality in the evaluation of acute clinical stroke. However, the rapidity with which CT density changes occur after acute, severe, focal ischemia cannot be determined clinically. Even if the time of symptom onset is known, clinical stroke severity is highly variable. We studied the time course of CT density change after severe, rapid onset, acute, focal ischemia as documented by stable xenon CT cerebral blood flow (CBF) in monkeys. Eight monkeys (Macaca mulatta) were subjected to transorbital occlusion of the left posterior cerebral, anterior, middle, and internal carotid arteries to induce focal ischemia. CT density Hounsfield units (HU), CBF by stable xenon CT, arterial blood pressure, and blood gases were measured before occlusion, immediately after occlusion, at 30 min, and hourly for up to 6 h. Occlusion of the cerebral arteries decreased CBF to 8 ± 5 ml/100 g/ min within 15 min postocclusion. At 6 h, CBF was unchanged at 9 ± 4 ml/100 g/ min. CT density within the ischemic core fell from 42 to 38 HU immediately after occlusion (P < 0.05), rose transiently, then fell at 2 h (P < 0.01) and plateaued at 36 ± 5 HU for a total decrease of 4–5 HU between 4 and 6 h poststroke. Changes in CT density lag severe focal ischemia by 2 h. Thus, when CT hypodensity is seen in acute stroke, it is likely 2 h old. It also provides an explanation for the phenomenon of clinical CT mismatch with clinical deficits and normal CT.

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Acknowledgments

This study was supported by NIH grant # NS051639, NS061216 and Praxair.

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Authors and Affiliations

  1. Department of Neurosurgery, University of New Mexico, 1101 Yale Blvd, Domenici Hall, BRaIN Center Rm. 1131B, Albuquerque, NM, 87106, USA

    Edwin M. Nemoto & Howard Yonas

  2. Tennessee Neurology Specialty, Franklin, TN, 37067, USA

    Oscar Mendez

  3. Frances Payne Bolton School of Nursing, Cleveland, OH, USA

    Mary E. Kerr

  4. Foundation Medical Partners, 105 Rowayton Avenue, Rowayton, CT, 06853, USA

    Andrew Firlik

  5. Piedmont Ortho/Sports Medicine, 4660 Riverside Drive, Macon, GA, 13210, USA

    Kevin Stevenson

  6. Department of Neurology, University of Pittsburgh, Pittsburgh, PA, 15213, USA

    Tudor Jovin

Authors
  1. Edwin M. Nemoto
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  2. Oscar Mendez
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  3. Mary E. Kerr
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  4. Andrew Firlik
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  5. Kevin Stevenson
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  6. Tudor Jovin
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  7. Howard Yonas
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Correspondence to Edwin M. Nemoto.

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Nemoto, E.M., Mendez, O., Kerr, M.E. et al. CT Density Changes with Rapid Onset Acute, Severe, Focal Cerebral Ischemia in Monkeys. Transl. Stroke Res. 3, 369–374 (2012). https://doi.org/10.1007/s12975-012-0193-6

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  • DOI: https://doi.org/10.1007/s12975-012-0193-6

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