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To the Editor: In their analysis of data from the National Institute of Neurological Disorders and Stroke (NINDS) study of recombinant tissue plasminogen activator (rt-PA), Dr Patel and colleagues¹ found that early ischemic changes (EICs) on computed tomography (CT) within 3 hours of stroke onset are correlated with later severity of stroke, but that EIC is not helpful in determining which patients would benefit from rt-PA. Patel et al also found a relatively low rate of EICs. In contrast with the ECASS II cohort,² where the frequency of EIC was 58% for the first hour, 66% for the second, and 65% for the third, Patel et al found EICs in only 31% of their patients. Other studies also found higher incidence rates for EIC within 3 hours of stroke onset.^3-4 Explanations for this discrepancy may include technical reasons as well as different definitions for EICs.

The positive predictive value of . . . [Full Text of this Article]

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