Relation between cerebral blood flow and neurologic deficit resolution in acute ischemic stroke.
OBJECTIVE
Early intervention remains the key to acute ischemic stroke therapy. Many patients whose deficits would later resolve without intervention are exposed to the risks of stroke treatment without benefit. The purpose of this study was to determine whether patients with transient deficits could be distinguished from patients with evolving strokes on the basis of acute cerebral blood flow (CBF) measurements before any clinical distinction could be made.


METHODS
Fifty-three patients who presented with acute hemispheric stroke symptoms and who underwent xenon-enhanced CT (XeCT) CBF studies within 8 hours of onset of symptoms (and before any clinical improvement) were studied.


RESULTS
Eight patients (15%) had a complete resolution of their symptoms within 24 hours (not related to treatment). All eight patients with deficits that resolved had normal CBF in the symptomatic vascular territories (mean time to XeCT = 3 hours, 51 min). Mean CBF in the regions of interest of the symptomatic vascular territories of patients who had deficits that resolved was 35.4 +/- 8.1 mL x 100 g(-1) x min(-1) compared with 17.3 +/- 9.3 mL x 100 g(-1) x min(-1) of patients with evolving strokes (p = 0.00058).


CONCLUSIONS
Patients with ischemic neurologic deficits that will later resolve can be acutely distinguished from patients with evolving cortical infarctions using XeCT CBF measurements. CBF measurements may assist in the triage of patients for acute stroke therapy by selecting patients with a favorable prognosis and may not benefit from therapy but would still be exposed to the potential risks and expense of treatment.
Stroke Institute, University of Pittsburgh Medical Center, PA 15213, USA.
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Firlik
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Rubin
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Yonas
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Wechsler
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D000075202:Contraindications; D005260:Female; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000503:physiopathology / Q000628:therapy*; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D018570:Risk Assessment; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed / Q000379:methods; D014978:Xenon
D014978:Xenon