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Perfusion CT helps decision making for thrombolysis when there is no clear time of onset
  1. K D Hellier1,
  2. J L Hampton1,
  3. J V Guadagno2,
  4. N P Higgins3,
  5. N M Antoun3,
  6. D J Day2,
  7. J H Gillard3,
  8. E A Warburton1,2,
  9. J-C Baron2
  1. 1Department of Stroke Medicine, Addenbrooke’s Hospital, Cambridge, UK
  2. 2Department of Clinical Neurosciences, Addenbrooke’s Hospital, Cambridge, UK
  3. 3Department of Radiology, Addenbrooke’s Hospital, Cambridge, UK
  1. Correspondence to:
 Professor Jean-Claude Baron
 Department of Neurology, Addenbrooke’s Hospital, Box 83, Hills Road, Cambridge, CB2 2QQ, UK; jcb54{at}


Current guidelines on thrombolysis post stroke with recombinant tissue plasminogen activator (rt-PA) exclude its use where time of onset is unknown, thus denying some patients potentially beneficial treatment. Contrast enhanced perfusion computed tomography (pCT) imaging can be used together with plain CT and information on clinical deficits to decide whether or not thrombolysis should be initiated even though the exact time of stroke onset is unknown. Based on the results of pCT and CT, rt-PA was administered to two patients with unknown time of stroke onset; one of the patients also underwent suction thrombectomy. Results in both cases were excellent.

  • CBV, cerebral blood volume
  • CT, computed tomography
  • DWI, diffusion weighted MRI
  • IA, intra-arterial
  • MRI, magnetic resonance imaging
  • NIHSS, National Institute of Health Stroke Scale
  • pCT, perfusion CT
  • PWI, perfusion weighted MRI
  • rt-PA, recombinant tissue plasminogen activator
  • TTP, time to peak
  • ischaemic stroke
  • penumbra
  • perfusion CT
  • thrombolysis

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  • Competing interests: none declared

  • Patient consent was obtained for the publication of these details