Combined carotid and transcranial ultrasound findings compared with clinical classification and stroke severity in acute ischemic stroke.
BACKGROUND
The aim of this study was to assess the association between cerebral hemodynamics and the clinical picture as defined by the Oxfordshire Community Stroke Project (OCSP) classification, as well as the clinical severity as defined by the National Institute of Health Stroke Scale (NIHSS) within the first 6 h of an acute middle cerebral artery (MCA) stroke onset.


METHODS
70 unselected patients were grouped according to the OCSP classification and NIHSS. All patients immediately had extracranial and transcranial Doppler (TCD) ultrasound examinations.


RESULTS
In the study population as a whole, there was a significant association between intracranial vascular pathology and the OCSP classification (p<0.001) as well as the NIHSS score (p<0.001). In patients with severe stroke, however, TCD demonstrated the hypothesized proximal MCA(1) occlusion in only 34% of patients with an OCSP-defined total anterior circulation syndrome and in 42% of patients with an NIHSS score of >or=15. In moderate stroke, the OCSP classification was misleading in almost half of the patients with a partial anterior circulation syndrome, i.e. a hypothesized distal MCA(2) occlusion suitable for thrombolysis.


CONCLUSIONS
Neither the OCSP classification nor the NIHSS grading provided reliable information about the site or presence of intracranial arterial occlusion in acute stroke within the first 6 h after stroke onset in the individual patient. The results of this study strongly suggest that selection of acute ischemic stroke patients for thrombolysis should also include an assessment of cerebral hemodynamics.
Thomassen
Lars
L
Department of Neurology, Haukeland University Hospital, Bergen, Norway. lars.thomassen@haukeland.no
Waje-Andreassen
Ulrike
U
Naess
Halvor
H
Aarseth
Jan
J
Russell
David
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000145:classification* / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow / Q000502:physiology; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013997:Time Factors; D017585:Ultrasonography, Doppler, Transcranial