0:01

It has been shown that high-volume strokes on CT

0:07

imaging are a relative contraindication to thrombolysis

0:14

because of the higher rate of potential hemorrhage into

0:18

the infarct and the lower, uh, the worse prognosis.

0:23

So the volume that most people have,

0:26

yeah, settled on has been 70 ccs of tissue, that when

0:32

you have greater than 70 ccs of infarcted tissue,

0:36

then the likelihood of having a good prognosis and,

0:40

uh, the—is low, and—and the likelihood of having

0:44

hemorrhage into the stroke with thrombolysis is high.

0:48

Now, most people don't have a volumetric

0:50

analysis package to look for 70 ccs of stroke.

0:54

So instead, most people have

0:56

gravitated to the ASPECTS score.

0:59

The ASPECTS score looks at the anatomy and assigns

1:03

different regions of the anatomy a numerical

1:07

score so that the caudate, the insular

1:10

ribbon, the internal capsule, the lentiform

1:11

nucleus—each of these counts as one point.

1:15

And then you have these different areas of

1:17

the middle cerebral artery distribution, seen

1:19

in this diagram as six additional points.

1:23

The ASPECTS score is subtracted from 10.

1:28

And therefore, if you have a stroke that involves

1:31

the lentiform nucleus and the M4 area

1:34

and the M6 area, you would subtract three

1:37

from 10 and give the ASPECTS score a seven.

1:40

So, obviously, the lower the ASPECTS score, the

1:43

greater the volume of infarction and the worse the

1:47

prognosis, and the worse the risk of hemorrhage.

1:52

So ASPECTS, just to refresh your memory, stands

1:56

for the Alberta Stroke Program Early CT Score.

2:02

And again, we deduct from 10.

2:04

So if we are looking at this patient with an acute

2:07

infarction in the left middle cerebral artery

2:09

distribution, we see that there is involvement of

2:12

the caudate nucleus, the insular ribbon, the internal

2:17

and external capsule, the lentiform nucleus.

2:22

The M1 segment.

2:23

So here's the Sylvian fissure.

2:25

Here's Sylvian.

2:26

The M1 portion is involved.

2:28

The M2 portion is involved.

2:29

The M3 portion is involved.

2:32

The M4, M5, M6.

2:34

So I would give this, you know, all 10, 10 points.

2:38

This was scored a one out of 10.

2:40

I think that there was a feeling that potentially

2:44

the lentiform nucleus was spared, or there

2:47

was a portion of the M3 that was spared.

2:49

But in any case, this is how—

2:51

The, uh, ASPECT score is utilized to determine

2:55

the volume of infarcted tissue. ASPECT score,

2:59

because it relates to the likelihood of success

3:02

of thrombolysis, is one of the parameters that is

3:07

utilized by neurologists for determining whether

3:10

or not to recommend intravenous thrombolysis.

ASPECTS Score

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