Stroke, Vol 25, 382-384, Copyright © 1994 by American Heart Association
DG Grosset, D Georgiadis, I Abdullah, I Bone and KR Lees
BACKGROUND AND PURPOSE: Doppler ultrasound detection of emboli signals may
assist in distinguishing embolic from thrombotic stroke. Selected patient
groups have a high incidence of such signals. We have examined consecutive
stroke cases to identify the incidence of Doppler emboli in different
etiologic subtypes of stroke. METHODS: Forty-five patients presenting with
first-ever acute carotid territory cerebral ischemia were studied
prospectively. Transcranial Doppler examination of both middle cerebral
arteries, carotid color duplex ultrasound, and transthoracic or
transesophageal echocardiography were completed within 48 hours of deficit
onset. Clinical and imaging data were interpreted independent of emboli
data, and stroke etiology was classified according to recent multicenter
trial criteria. RESULTS: Middle cerebral artery signals were identified in
at least one cerebral hemisphere in 41 of the 45 patients. Emboli signals
were present in 29 of these 41 cases (71%). These signals were bilateral in
22, within the affected (symptomatic) cerebral hemisphere only in 5, and
contralateral only in 2 cases. No emboli signals were detected in any of 8
patients with lacunar stroke. The overall difference in emboli signal
counts between etiologic subgroups was significant (P = .001,
Kruskal-Wallis). A significantly higher emboli signal count was found
within affected cerebral hemispheres than contralaterally in the 8 patients
with large artery atherosclerosis (11.3 versus 1 signals per hour, median
[95% confidence interval, 3 to 40 and 0 to 3, respectively], P = .02), but
this interhemisphere difference was not present for other etiologic
subgroups. CONCLUSIONS: Emboli signals are common in patients with acute
stroke, with the notable exception of lacunar stroke. This is consistent
with the small vessel etiology for the latter group and provides support
for the relevance of Doppler emboli signal detection in thromboembolic
cerebrovascular disease.
ARTICLES
Doppler emboli signals vary according to stroke subtype
University Department of Medicine and Therapeutics, Western Infirmary, Glasgow, UK.
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