Toni D, Fiorelli M, Zanette E M, Sacchetti M L, Salerno A, Argentino C, Solaro M, Fieschi C
Department of Neurological Sciences, University La Sapienza, Rome, Italy.
Stroke. 1998 Jun;29(6):1144-8. doi: 10.1161/01.str.29.6.1144.
The purpose of our study was to investigate whether emergency transcranial Doppler (TCD) findings and their modifications over the first 48 hours are related to early neurological changes in acute ischemic stroke patients.
Ninety-three patients underwent CT scan within 5 hours of a first-ever ischemic hemispheric stroke, and TCD serial examinations at 6, 24, and 48 hours after stroke onset. We classified TCD findings as follows: normal; middle cerebral artery (MCA) asymmetry (asymmetry index between affected and contralateral MCAs below -21%); and MCA no-flow (absence of flow signal from the affected MCA in the presence of ipsilateral anterior and posterior cerebral artery signals through the same acoustic window). We considered early deterioration and early improvement to be a decrease or an increase of 1 or more points, respectively, in the Canadian Neurological Scale score over the same period.
At 6-hour TCD examination, MCA asymmetry and MCA no-flow were present in 6 (22%) and 2 (7%), respectively, 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. TCD 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%) improving 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 deteriorating patients (P = 0.03, chi 2 for trend, improving versus nonimproving irrespective of the timing of recanalization). One deteriorating patient (5%) developed a non-flow from an initial MCA asymmetry. Logistic regression selected normal TCD (odds ratio [OR], 0.17; 95% confidence interval [CI], 0.06 to 0.46) as an independent predictor of early 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.
TCD examination within 6 hours after stroke can help to predict both early deterioration and early improvement. Serial TCD shows that propagation of arterial occlusion is rarely related to early deterioration, whereas the fact that it can detect early recanalization (within 24 hours) in deteriorating patients and both early and late recanalization (after 24 hours) in improving patients suggests the existence of individual time frames for tissue recovery.
我们研究的目的是调查急性缺血性卒中患者的急诊经颅多普勒（TCD）检查结果及其在最初48小时内的变化是否与早期神经功能改变相关。
93例首次发生缺血性半球卒中的患者在发病5小时内接受了CT扫描，并在卒中发作后6、24和48小时进行了TCD系列检查。我们将TCD检查结果分类如下：正常；大脑中动脉（MCA）不对称（患侧与对侧MCA的不对称指数低于-21%）；以及MCA无血流（通过同一声学窗口在同侧大脑前动脉和大脑后动脉有信号的情况下，患侧MCA无血流信号）。我们将早期病情恶化和早期病情改善分别定义为在同一时期加拿大神经功能量表评分下降或上升1分或更多分。
在6小时TCD检查时，27例病情改善的患者中，分别有6例（22%）和2例（7%）出现MCA不对称和MCA无血流；46例病情稳定的患者中，分别有20例（43%）和10例（22%）出现上述情况；20例病情恶化的患者中，分别有9例（45%）和8例（40%）出现上述情况。其余患者TCD检查结果正常（P = 0.001）。在系列TCD检查中，我们在2例（25%）病情改善的患者、7例（23%）病情稳定的患者和5例（29%）病情恶化的患者中检测到早期（24小时内）再通（从无血流到不对称或正常，以及从不对称到正常），在4例（50%）病情改善的患者、6例（20%）病情稳定的患者中检测到晚期（24至48小时之间）再通，而病情恶化的患者中无一例出现晚期再通（P = 0.03，趋势检验的卡方值，无论再通时间如何，病情改善与未改善患者相比）。1例病情恶化的患者（5%）从最初的MCA不对称发展为无血流。逻辑回归分析选择正常TCD（比值比[OR]，0.17；95%置信区间[CI]，0.06至0.46）作为早期病情改善的独立预测因素，异常TCD（不对称加无血流）（OR，5.02；95%CI，1.31至19.3）作为早期病情恶化的独立预测因素。
卒中后6小时内的TCD检查有助于预测早期病情恶化和早期病情改善。系列TCD检查显示，动脉闭塞的进展很少与早期病情恶化相关，而它能在病情恶化的患者中检测到早期（24小时内）再通，在病情改善的患者中检测到早期和晚期（24小时后）再通，这表明存在个体组织恢复的时间框架。
