Computed tomography in acute cerebral ischemia

Summary Computed tomography (CT) is the first step in the radiological diagnostics of brain emergencies. We intend to study which pathophysiological changes are detected by CT and how CT contributes to prognosis and patient management in acute cerebral ischemia. We review recent publications about the role of CT in acute cerebral ischemia. Ischemic brain edema is associated with a decreased X-ray attenuation. Computed tomography is thus highly sensitive in detecting irreversibly damaged ischemic brain tissue. Patients showing large volumes of ischemic edema, exceeding one third of the middle cerebral artery territory, do not benefit from thrombolysis and have an increased risk of brain hemorrhage. The brain territory at risk from ischemia can be detected by CT angiography. To combine CT with CT angiography is a pragmatic approach which enables carefully directed treatment in acute cerebral ischemia.