{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T19:17:09Z","timestamp":1778786229590,"version":"3.51.4"},"reference-count":29,"publisher":"Cambridge University Press (CUP)","issue":"5","license":[{"start":{"date-parts":[[2014,12,2]],"date-time":"2014-12-02T00:00:00Z","timestamp":1417478400000},"content-version":"unspecified","delay-in-days":2222,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Can. j. neurol. sci."],"published-print":{"date-parts":[[2008,11]]},"abstract":"<jats:sec id=\"S0317167100009367_abs1\"><jats:title>Objectives:<\/jats:title><jats:p>The current management of acute ischemic stroke is intravenous (IV) recombinant tissue plasminogen activator (rtPA). The presence of a hyperdense middle cerebral artery sign (HMCAS) on pre-treatment head computed tomogram (CT) is considered a poor prognostic sign. We compared the clinical outcome in IV rtPA-treated patients with and without a HMCAS.<\/jats:p><\/jats:sec><jats:sec id=\"S0317167100009367_abs2\"><jats:title>Design:<\/jats:title><jats:p>Retrospective analysis of prospectively collected cases treated with IV rtPA within three hours. Inclusion criteria were the presence of: i) an anterior circulation stroke; ii) a pre-treatment CT available; iii) a pre-treatment National Institutes of Health (NIH) stroke scale (NIHSS) score; and iv) a modified Rankin Score (mRS) at three months.<\/jats:p><\/jats:sec><jats:sec id=\"S0317167100009367_abs3\"><jats:title>Results:<\/jats:title><jats:p>One hundred and thirty patients were eligible for the analysis, 64 (49%) had a HMCAS. The HMCAS group had a trend toward a higher mean (\u00b1SD) pre-treatment NIHSS score compared to the non-HMCAS group (13.9\u00b16 vs. 12.2\u00b16; p=0.12). Accordingly, there were more patients with severe strokes (NIHSS&gt;10) in the HMCAS group compared to the non-HMCAS one (48\/64=75% vs. 35\/66=53%; p=0.009). The mean (\u00b1SD) NIHSS score 24 hours after treatment was 10.6 (\u00b18) in the HMCAS group and 8.3 (\u00b17) in the non-HMCAS group (p=0.08). In a multiple logistic regression analysis, the only independent predictor of poor outcome (mRS 3-6) was pre-treatment NIHSS score (p&lt;0.001).<\/jats:p><\/jats:sec><jats:sec id=\"S0317167100009367_abs4\"><jats:title>Conclusion:<\/jats:title><jats:p>Patients with a HMCAS receiving IV rtPA did not fare worse at three months despite a greater proportion of patients with more severe strokes. Based on the current knowledge, IV rtPA remains a good treatment for patients with a HMCAS within three hours of symptom onset.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0317167100009367","type":"journal-article","created":{"date-parts":[[2014,12,12]],"date-time":"2014-12-12T15:15:22Z","timestamp":1418397322000},"page":"583-587","source":"Crossref","is-referenced-by-count":10,"title":["Acute Stroke with Hyperdense Middle Cerebral Artery Sign Benefits from IV rtPA"],"prefix":"10.1017","volume":"35","author":[{"given":"M C","family":"Tartaglia","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Di Legge","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G","family":"Saposnik","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"V","family":"Jain","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R","family":"Chan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Bussi\u00e8re","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"V","family":"Hachinski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C","family":"Frank","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K","family":"Hesser","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D","family":"Pelz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2014,12,2]]},"reference":[{"key":"S0317167100009367_ref023","doi-asserted-by":"publisher","DOI":"10.1161\/hs0102.100481"},{"key":"S0317167100009367_ref006","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.149.3.583"},{"key":"S0317167100009367_ref014","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000208407.69544.5a"},{"key":"S0317167100009367_ref011","doi-asserted-by":"publisher","DOI":"10.1007\/BF00588219"},{"key":"S0317167100009367_ref028","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2352040262"},{"key":"S0317167100009367_ref001","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2004.038158"},{"key":"S0317167100009367_ref002","volume-title":"International Stroke Conference","author":"Ciccone","year":"2005"},{"key":"S0317167100009367_ref022","doi-asserted-by":"publisher","DOI":"10.1001\/jama.292.15.1839"},{"key":"S0317167100009367_ref020","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000020363.23725.67"},{"key":"S0317167100009367_ref026","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.53.1.126"},{"key":"S0317167100009367_ref007","doi-asserted-by":"publisher","DOI":"10.1007\/BF00395612"},{"key":"S0317167100009367_ref009","first-page":"257","article-title":"Thrombus localization with emergency cerebral CT","volume":"13","author":"Tomsick","year":"1992","journal-title":"AJNR Am J Neuroradiol"},{"key":"S0317167100009367_ref004","doi-asserted-by":"publisher","DOI":"10.1111\/j.1552-6569.2004.tb00245.x"},{"key":"S0317167100009367_ref019","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.30.12.2598"},{"key":"S0317167100009367_ref015","doi-asserted-by":"publisher","DOI":"10.1080\/028418501127346800"},{"key":"S0317167100009367_ref003","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199512143332401"},{"key":"S0317167100009367_ref005","first-page":"79","article-title":"Prognostic value of the hyperdense middle cerebral artery sign and stroke scale score before ultraearly thrombolytic therapy","volume":"17","author":"Tomsick","year":"1996","journal-title":"AJNR Am J Neuroradiol"},{"key":"S0317167100009367_ref008","doi-asserted-by":"publisher","DOI":"10.1007\/BF00344173"},{"key":"S0317167100009367_ref010","doi-asserted-by":"publisher","DOI":"10.1007\/BF00588557"},{"key":"S0317167100009367_ref012","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.9.1145"},{"key":"S0317167100009367_ref013","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.30.4.769"},{"key":"S0317167100009367_ref016","doi-asserted-by":"publisher","DOI":"10.1159\/000057847"},{"key":"S0317167100009367_ref017","first-page":"3","article-title":"Neuroradiologic evaluation of patients with acute stroke treated with recombinant tissue plasminogen activator. 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