TRANSCRANIAL DOPPLER IN ACUTE ISCHEMIC STROKE OF THE MIDDLE CEREBRAL-ARTERY TERRITORIES

We have investigated the reliability of transcranial doppler compared with cerebral angiography in acute ischemic stroke in the middle cereb ral artery territories. We studied 48 patients, 28 men and 21 women, m ean age 68.1 (range 54-75), observed within 5 h of the onset of ischem ic stroke in the middle cerebral artery territory. Ultrasound evaluati on (duplex scanner and transcranial doppler) and cerebral angiography were carried out in close sequence immediately after CT scan. CT was r epeated by Day 7 to estimate the infarct size: 27/48 patients had intr acranial arterial obstructions. An acoustic temporal ''window'' was no t found in 6.25%. Transcranial doppler showed a sensitivity of 80.0% a nd a specificity of 90.0% compared with cerebral Angiography for patie nts with patent acoustic temporal windows''. Accuracy was 79.2%, when patients with no ''windows'' were included. With respect to intracrani al internal carotid artery and middle cerebral artery mainstem, transc ranial doppler showed a sensitivity of 95.0%, and a specificity of 92. 0%. Including patients with no windows, accuracy was 87.5%. Conclusion s: Our data suggest that Transcranial Doppler can be reliably used to demonstrate intracranial internal carotid artery or middle cerebral ar tery mainstem obstructions in the acute phase of a brain infarction.