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Alberta Stroke program Early CT score (ASPECT) scoring system
🧠 About
- The Alberta Stroke Program Early CT Score (ASPECTS) is a 10-point scoring system used to assess early ischemic changes in patients with middle cerebral artery (MCA) infarction.
- It evaluates two main CT axial levels (ganglionic & supraganglionic). The score starts at 10, with 1 point subtracted for each MCA region showing early ischemia.
- Higher scores = smaller infarcts, better prognosis. Lower scores = larger infarcts, worse outcomes.
🖼️ Imaging
📊 Scoring System
| Region Assessed | Deduction (-1 for ischemia) |
|---|---|
| Ganglionic Level | |
| M1 – lateral MCA cortex | -1 |
| M2 – anterior MCA cortex | -1 |
| M3 – posterior MCA cortex | -1 |
| Lentiform nucleus | -1 |
| Caudate nucleus | -1 |
| Internal capsule | -1 |
| Insular cortex | -1 |
| Supraganglionic (Centrum Semiovale) Level | |
| M4 – lateral MCA cortex | -1 |
| M5 – anterior MCA cortex | -1 |
| M6 – posterior MCA cortex | -1 |
| Final Score | 0 = complete MCA infarction ❌
10 = normal CT ✅ |
🔎 Clinical Uses
- Quantifies early ischemic damage in MCA stroke patients.
- ASPECTS ≥ 8 → better outcomes, often suitable for reperfusion therapies.
- ASPECTS ≤ 7 → associated with increased disability and mortality.
- Helps guide treatment: thrombolysis & especially mechanical thrombectomy decisions.
- Note: ASPECTS is not mandatory before giving IV thrombolysis, but provides objective CT scoring that supports decision-making in MDT discussions.
💡 Teaching Pearls
- Always review all CT axial slices – not just the “two classic cuts.” - Look for early ischemic signs: loss of grey-white matter differentiation, sulcal effacement, subtle hypodensity. - Prognosis worsens sharply if ASPECTS ≤ 7. - Remember: ASPECTS complements but does not replace clinical judgement + CTA/CT perfusion.
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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