EARLY SPONTANEOUS IMPROVEMENT AND DETERIORATION OF ISCHEMIC STROKE PATIENTS - A SERIAL STUDY WITH TRANSCRANIAL DOPPLER ULTRASONOGRAPHY

Background and Purpose-The purpose of our study was to investigate whe ther emergency transcranial Doppler (TCD) findings and their modificat ions over the first 48 hours are related to early neurological changes in acute ischemic stroke patients. Methods-Ninety-three patients unde rwent CT scan within 5 hours of a first-ever ischemic hemispheric stro ke, and TCD serial examinations at 6, 24, and 48 hours after stroke on set. We classified TCD findings as follows: normal; middle cerebral ar tery (MCA) asymmetry (asymmetry index between affected and contralater al MCAs below -21%); and MCA no-flow (absence of flow signal from the affected MCA in the presence of ipsilateral anterior and posterior cer ebral artery signals through the same acoustic window). We considered early deterioration and early improvement to be a decrease or an incre ase of 1 or more points, respectively, in the Canadian Neurological Sc ale score over the same period. Results-At 6-hour TCD examination, MCA asymmetry and MCA no-flow were present in 6 (22%) and 2 (7%), respect ively, of 27 improving patients; in 20 (43%) and 10 (22%) of 46 stable patients, and in 9 (45%) and 8 (40%) of 20 deteriorating patients. TC D findings were normal in the remaining patients (P=0.001). At serial TCD, we detected early (within 24 hours) recanalization (from no-flow to asymmetry or normal and from asymmetry to normal) in 2 (25%) improv ing patients, in 7 (23%) stable patients, and in 5 (29%) deteriorating patients and late (between 24 and 48 hours) recanalization in 4 (50%) improving patients, in 6 (20%) stable patients, and in none of the de teriorating patients (P=0.03, chi(2) for trend, improving versus nonim proving irrespective of the timing of recanalization). One deteriorati ng patient (5%) developed a no-flow from an initial MCA asymmetry. Log istic regression selected normal TCD (odds ratio [OR], 0.17; 95% confi dence interval [CI], 0.06 to 0.46) as an independent predictor of earl y improvement and abnormal TCD (asymmetry plus no-flow) (OR, 5.02; 95% CI, 1.31 to 19.3) as an independent predictor of early deterioration. Conclusions-TCD examination within 6 hours after stroke can help to p redict both early deterioration and early improvement. Serial TCD show s that propagation of arterial occlusion is rarely related to early de terioration, whereas the fact that it can detect early recanalization (within 24 hours) in deteriorating patients and both early and late re canalization (after 24 hours) in improving patients suggests the exist ence of individual time frames for tissue recovery.