CEREBRAL HYPOPERFUSION IN STROKE PROGNOSIS AND BRAIN RECOVERY

Background and Purpose: The value of acute cerebral blood flow measure ments in stroke prognosis is controversial. No previous study has dete rmined whether acute perfusion deficits independently add to a validat ed clinical prognostic score. We aimed to compare the value of acute h ypoperfusion deficits with a quantitative clinical score in stroke pro gnosis and to correlate the changes in perfusion with brain recovery. Methods: Volumetric analysis of regional hypoperfusion was performed i n 38 patients with middle cerebral infarction within 72 hours of onset by use of single photon emission computed tomography and Tc-99m hexam ethylpropylene amine oxime. Stroke severity was assessed by the Canadi an Neurological Score and Barthel Index. Allen's prognostic score was determined acutely in all patients. Clinical outcome was evaluated in 36 or 38 patients, of whom 18 had repeat blood flow studies. Results: Acute hypoperfusion correlated with both the outcome Barthel Index (P< .001, r=-.61) and Canadian Neurological Score (P<.00 1, r = -.64). All en's score correlated better with both the outcome Barthel Index (P<.0 01, r=.80) and Canadian Neurological Score (P<.001, r=.81). Acute hypo perfusion deficits, after allowing for Allen's score, independently pr edicted neurological but not functional outcome. Despite overall neuro logical improvement, mean hypoperfusion increased on the repeat blood flow studies (P<.05). Conclusions: Volumetric analysis of acute region al hypoperfusion within 72 hours of onset predicts stroke outcome afte r 3 months, but Allen's score is a better prognostic method. Neurologi cal recovery is not associated with chronic infarct reperfusion.