Imagerie cérébrale supplémentaire après un accident vasculaire cérébral en médecine interne : fréquemment demandée mais une rare implication diagnostique ou thérapeutique

Abstract

To assess the interest of a second computed tomography (CT) scan of the brain during hospitalization of stroke patients in an internal medicine department and study the characteristics of these patients. This retrospective study included 110 patients diagnosed with stroke between January 1, 2002, and August 31, 2004 in an internal medicine department. All patients had a brain CT scan soon after admission - within three hours, on average, of arrival at the hospital; however, the mean delay between the onset of symptoms and hospital arrival was 40 hours. Mean hospital stay was 19 days. Eighty patients (73%) had at least one more scan. Indications for these scans were: no acute cerebral ischemia on the initial image (34%), routine follow-up or reason not specified (34%), worsening of neurologic status (15%), before oral anticoagulation (5%), to search a tumor (5%), to look for a cause (4%), and clinic-radiologic discordance (3%). Only 29% of the indications had any diagnostic or therapeutic reason. Among these 80 patients, the repeat brain scan resulted in a change in the initial diagnosis for 4 patients (5%) and in a change of therapy for 11 (14%). In our study, repeat CT imaging was frequently ordered in ischemic stroke, despite the not uncommon absence of any diagnostic or therapeutic reasons. To optimize the use of medical resources and avoid unnecessary imaging, it would be useful to identify subgroups of patients for whom repeat imaging might be of interest.