Microembolic signals and clinical outcome in patients with acute stroke - a prospective study

The occurence of microembolic signals (MES) in patients with transient isch emic attack (TLA) or stroke has already been described; the influence of th e time interval between onset of symptoms and transcranial Doppler monitori ng (TCD) on the MES rate or MES prevalence and the possible prognostic valu e of the early detected MES rate on the outcome of TIA or stroke symptoms i n a 3 month interval are discussed. In a prospective study we evaluated 61 patients consecutively admitted to our stroke unit after their first ischem ic neurological deficit involving the vascular territory of MCA and/or ACA. All of the patients underwent a 30-minute bilateral transcranial Doppler m onitoring of their MCAs for the identification of MES. Monitoring was perfo rmed within 12.3 + -9.3 (average mean + -SD) hours of stroke onset for the first time, the second time 48 hours after first TCD monitoring. Prognosis for the recovery of neurological deficits was evaluated by using the Barthe l index (BI) and Scandinavian Stroke Scale (SSS) at the time of admission o f the patient to the stroke unit, and with Barthel indices after one month and after 3 months. As a result, 56% of all patients showed MES in at least one of the two registrations. MES were recorded not only on the symptomati c side. The MES prevalence between both TCD monitorings was significantly d ifferent (total MES prevalence: 1(st) TCD: 26 patients; 2(nd) TCD: 13 patie nts; p < 0.04; ipsilateral MES prevalence: 1(st) TCD: 19 patients; 2(nd) TC D: 9 patients; p < 0.01). The regression analysis showed a significant infl uence of the total MES rate on both neurological scores at admission (SSS: 0.03; Barthel index: 0.01), but not for the Barthel scores after one and th ree months. Ln conclusion, we found an influence of the time interval betwe en onset of neurological symptoms of TLA or stroke on the MES rate and the prevalence of MES. The prevalence of MES or the MES rate, found after a sho rt time interval to the onset of symptoms, did not have a prognostic value on the outcome of neurological deficits up to a three month follow-up.