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(Stroke. 2008;39:3255.)
© 2008 American Heart Association, Inc.

Original Contributions

Can Early Neurosonology Predict Outcome in Acute Stroke?

A Metaanalysis of Prognostic Clinical Effect Sizes Related to the Vascular Status

Erwin Stolz, MD, PhD; Francesca Cioli, MD; Jens Allendoerfer, MD; Tibo Gerriets, MD; Massimo Del Sette, MD Manfred Kaps, MD, PhD

From the Department of Neurology (E.S., J.A., T.G., M.K.), Justus-Liebig-University, Germany; the Department of Neurology and Department of Neuroscience, Ophthalmology, and Genetics (F.C., M.D.S.), University of Genova, Italy; and the Ultrasound Subnet of the Competence Network Stroke (E.S., M.K.), Germany.

Correspondence to Erwin Stolz, MD, PhD, Department of Neurology, Justus-Liebig-University, Am Steg 14, D-35385 Giessen, Germany. E-mail erwin.stolz{at}neuro.med.uni-giessen.de

Background and Purpose— Prediction of short- and long-term prognosis is an important issue in acute stroke care. This metaanalysis explores the prognostic value of initial bed-side transcranial ultrasound in acute stroke.

Methods— All studies prospectively applying TCCS or TCD within 24 hours of symptom onset in acute stroke, with a minimal cohort size of 20 patients, and reporting clinical outcome variables in relation to the vascular findings were included into this metaanalysis. Study quality was assessed by 2 independent reviewers.

Results— Twenty-five studies with 1813 included patients identified by electronic and manual search fulfilled the inclusion criteria. Middle cerebral artery (MCA) occlusion was associated with a significantly increased risk for a fatal course of stroke (OR 2.46, 95% CI 1.33 to 4.52). Patients with patent MCA were more likely to clinically improve within 4 days than patients with MCA occlusion (OR 11.11, 95% CI 5.44 to 22.69). Full recanalization within 6 hours after symptom onset was highly significantly associated with clinical improvement within 48 hours (OR 5.64, 95% CI 3.82 to 8.31) and functional independence after 3 months (OR 6.07, 95% CI 3.94 to 9.35).

Conclusions— Transcranial ultrasound provides important information on prognosis in patients with acute stroke.

Key Words: transcranial Doppler sonography • transcranial color-coded duplex sonography • acute stroke • metaanalysis • outcome