Shams ur Rehman, Muhammad Ali Khan.
Clinical versus C.T. Scan diagnosis in Stroke – A comparative study of 50 cases.
J Ayub Med Coll Abottabad Jan ;14(1):2-5.

Background: Cerebrovascular disease is one of the three leading causes of death in the world along with cancer and heart disease. Differentiation between cerebral infarction and intracerebral haemorrhage is important because now a days proper management of the acute stroke syndrome is based on the correct diagnosis of the pathological type. This study compared clinical and C.T. scan diagnosis of stroke and determined the reliability of the clinical diagnosis in cases of stroke. Methods: This study was conducted on 50 patients of stroke at Postgraduate Medical Institution, Lady Reading Hospital, Peshawar from Jan 1995 to May 1996. Clinical diagnoses were made in conformity with criteria for clinical diagnosis of intracranial haemorrhage, cerebral infarction due to embolism or thrombosis. The clinical diagnosis was then compared with the CT diagnosis. Results: We found that from careful history and clinical examination differentiation could be made between cerebral infarction and haemorrhage. In our study at Government Lady Reading Hospital, cerebral hemorrhage accounted for 42% of cases of stroke and cerebral infarction in 58%. Conclusions: In order to make a clinical diagnosis of stroke, a detailed history and thorough clinical examination is mandatory. As far as treatment planning is concerned clinical diagnosis of stroke is not safe enough as a guide for anticoagulant or thrombolytic therapy. In order to confirm the aetiological diagnosis of stroke one must rely on C.T. scan examination.

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Therapeutic decisions regarding management of stroke require accurate diagnosis of stroke subtypes [ischemic or hemorrhagic]. Clinical distinction between cerebral hemorrhage and infarction on the basis of patient’s clinical features alone has been shown to be unreliable{1,2} as there is a considerable overlap in the clinical features of ischemic and hemorrhagic stroke. Computed tomography is safe and most accurate in distinguishing cerebral hemorrhage from infarction {3}. CT scan has the sensitivity of nearly 100 % for intra cerebral hemorrhage and 95% for subarachnoid hemorrhage {4}. If CT scan is not available, then the only clinical judgment is not useful and several weighted clinical scoring systems like Allen Stroke Score {Guy’s Hospital Score}{2} and Siriraj Stroke Score{5},based on the discriminate analysis technique, may be used for better diagnostic gain. We have used these score in Khyber Teaching hospital peshawar, the results although promising, however even these scores lack sufficient validity to be used in the randomization of patients into treatment trials using thrombolytic or anti thrombotic drugs in the absence of neuroimaging techniques (6). 1-) Von Arbin M, deFaire u, Helmers C , Miah K, Murray V. Accuracy of bedside diagnosis in stroke. Stroke 1981;12:288-93. 2) Allen CM. Clinical diagnosis of the acute stroke syndromes.Q J Med.1983 Autumn;428(208):515-23. 3) Sandercock P A, Allen CM, Corston R N, Harrison MJ, Warlow CP. Clinical diagnosis of intracranial hemorrhage using Guy’s Hospital Score. Br.Med.J.(Clin Res.Ed.)1985 Dec.14;291(6510):1675-7. 4)Vuadens P, Bougousslavsky J. Diagnosis as a guide to stroke therapy. Lancet 1998;352[Supll III]:5-9 5)Poungvarin N, Viriyavejakul A Komonotric. Siriraj stroke score and validation study to distinguish supratentorial intracerebral hemorrhage from infarction. BMJ 1991 Jun 29;302(6792):1565-7. 6)Hawkins G C, Bonita R, Broad J B, Anderson N E. Inadequacy of clinical scoring systems to differentiate stroke subtypes in population based studies. Stroke 1995;26:1338-42
Posted by: lachvi on May 2002

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