From the Department of Neurological Sciences, University La Sapienza,
Rome, Italy.
Correspondence and reprint request to Dr Danilo Toni, Department of Neurological Sciences, I Chair of Neurology, University La Sapienza, Viale dell'Università 30, 00185 Rome, Italy. E-mail s.u.roma{at}iol.it
Background and Purpose—The purpose
of our study was to investigate whether emergency
transcranial Doppler (TCD) findings and their
modifications over the first 48 hours are related to early neurological
changes in acute ischemic stroke patients.
Methods—Ninety-three patients underwent CT scan within 5 hours of
a first-ever ischemic hemispheric stroke, and TCD serial
examinations at 6, 24, and 48 hours after stroke onset. We classified
TCD findings as follows: normal; middle cerebral artery (MCA) asymmetry
(asymmetry index between affected and contralateral MCAs below –21%);
and MCA no-flow (absence of flow signal from the affected MCA in the
presence of ipsilateral anterior and posterior cerebral artery signals
through the same acoustic window). We considered early deterioration
and early improvement to be a decrease or an increase of 1 or more
points, respectively, in the Canadian Neurological Scale score over the
same period.
Results—At 6-hour TCD examination, MCA asymmetry and MCA no-flow
were present in 6 (22%) and 2 (7%), respectively, of 27 improving
patients; in 20 (43%) and 10 (22%) of 46 stable patients, and in 9
(45%) and 8 (40%) of 20 deteriorating patients. TCD findings were
normal in the remaining patients (P=0.001). At serial
TCD, we detected early (within 24 hours)
recanalization (from no-flow to asymmetry or normal
and from asymmetry to normal) in 2 (25%) improving patients, in 7
(23%) stable patients, and in 5 (29%) deteriorating patients and late
(between 24 and 48 hours) recanalization in 4
(50%) improving patients, in 6 (20%) stable patients, and in none of
the deteriorating patients (P=0.03,
Conclusions—TCD examination within 6 hours after stroke can help
to predict both early deterioration and early improvement. Serial TCD
shows that propagation of arterial occlusion is rarely
related to early deterioration, whereas the fact that it can detect
early recanalization (within 24 hours) in
deteriorating patients and both early and late
recanalization (after 24 hours) in improving
patients suggests the existence of individual time frames for tissue
recovery.
© 1998 American Heart Association, Inc.
Original Contributions
Early Spontaneous Improvement and Deterioration of Ischemic Stroke Patients
A Serial Study With Transcranial Doppler Ultrasonography
2 for
trend, improving versus nonimproving irrespective of the timing of
recanalization). One deteriorating patient (5%)
developed a no-flow from an initial MCA asymmetry. Logistic regression
selected normal TCD (odds ratio [OR], 0.17; 95% confidence interval
[CI], 0.06 to 0.46) as an independent predictor of early improvement
and abnormal TCD (asymmetry plus no-flow) (OR, 5.02; 95% CI, 1.31 to
19.3) as an independent predictor of early deterioration.
Key Words: stroke, acute • stroke, ischemic • ultrasonography, Doppler • pathogenesis • prognosis
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