Can early neurosonology predict outcome in acute stroke?: a metaanalysis of prognostic clinical effect sizes related to the vascular status.
OBJECTIVE
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.
Department of Neurology, Justus-Liebig-University, Giessen, Germany. erwin.stolz@neuro.med.uni-giessen.de
Erwin
E
Stolz
Francesca
F
Cioli
Jens
J
Allendoerfer
Tibo
T
Gerriets
Massimo
M
Del Sette
Manfred
M
Kaps
D000208:Acute Disease; D001925:Brain Damage, Chronic / Q000209:etiology*; D015331:Cohort Studies; D042241:Early Diagnosis; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D015588:Observer Variation; D019095:Point-of-Care Systems; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D015424:Reperfusion; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods