Die Wertigkeit des EEC im Vergleich zum CT und zur SPECTUntersuchung in der Frühphase des ischämischen Hirninfarktes

To determine the sensitivity and clinical value of different diagnostic tools (CCT, EEC and SPECT) in patients with acute ischémie stroke. The subjects were 80 unselected patients with acute supratentorial cerebral ischemia. 25 patients suffered from TIAs, 19 patients from lacunar infarction and 36 patients from watershed, terminal and territorial infarction. In the first 36 hours after the onset of symptoms, CCT (n = 80), EEC (n = 79) and SPECT (n = 64) procedures were performed. A second CCT was undertaken in 70 cases 3 or 4 days later to demonstrate potential substantial lesion. The sensitivities of the methods for the recognition of a lateralized hemispheric disorder were evaluated and statistically compared. In large cortical infarctions (watershed, terminal or territorial infarction) the cerebral dysfunction was recognised in 100% of cases by EEC and SPECT, In lacunar infarction EEC demonstrated pathologic abnormalities in 73.7% and SPECT in 52.6%. In TIAs EEC revealed abnormalities in 41.7% and SPECT only in 9.5%; these differences were statistically significant (Me Nemar test; p- 0,0309). 2cd CCT was goldstandard (sensitivity 100%) for the evaluation of a substantial lesion in lacunar and large cortical infarction. In TIAs and lacunar infarction EEC is superior to SPECT for the recognition of a lateralized supratentorial cerebral ischemia. In large cortical infarction both methods show equal sensitivities. In the early phase of cerebral ischemia both methods are able to demonstrate cerebral disorder at a time when CCT is mostly unremarkable. SPECT seems to differentia more precisely in the early phase between minor and major stroke consequences.