Document Detail

Deterioration following spontaneous improvement : sonographic findings in patients with acutely resolving symptoms of cerebral ischemia.
MedLine Citation:
PMID:  10753998     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: Some stroke patients will deteriorate following improvement (DFI), but the cause of such fluctuation is often unclear. While resolution of neurological deficits is usually related to spontaneous recanalization or restoration of collateral flow, vascular imaging in patients with DFI has not been well characterized. METHODS: We prospectively studied patients who presented with a focal neurological deficit that resolved spontaneously within 6 hours of symptom onset. Patients were evaluated with bedside transcranial Doppler (TCD). Digital subtraction angiography (DSA), computed tomographic angiography (CTA), or magnetic resonance angiography (MRA) were performed when feasible. DFI was defined as subsequent worsening of the neurological deficit by >/=4 National Institutes of Health Stroke Scale points within 24 hours of the initial symptom onset. RESULTS: We studied 50 consecutive patients presenting at 165+/-96 minutes from symptom onset. Mean age was 61+/-14 years; 50% were females. All patients had TCD at the time of presentation, and 68% had subsequent angiographic examinations (DSA 10%, CTA 4%, and MRA 44%). Overall, large-vessel occlusion on TCD was found in 16% of patients (n=8); stenosis was found in 18% (n=9); 54% (n=27) had normal studies; and 6 patients (12%) had no temporal windows. DFI occurred in 16% (n=8) of the 50 patients: in 62% of patients with TCD and angiographic evidence of occlusion, in 22% with stenosis, and in 4% with normal vascular studies (P<0.001, Phi=0.523, chi(2)=12.05). DFI occurred in 31% of patients with large-vessel atherosclerosis, 23% with cardioembolism, and 9% with small-vessel disease when stroke mechanisms were determined within 2 to 3 days after admission (P=0.2, NS). CONCLUSIONS: DFI is strongly associated with the presence of large-vessel occlusion or stenosis of either atherosclerotic or embolic origin. Normal vascular studies and lacunar events were associated with stable spontaneous resolution without subsequent fluctuation. Urgent vascular evaluation may help identify patients with resolving deficits and vascular lesions who may be candidates for new therapies to prevent subsequent deterioration.
A V Alexandrov; R A Felberg; A M Demchuk; I Christou; W S Burgin; M Malkoff; A W Wojner; J C Grotta
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  31     ISSN:  0039-2499     ISO Abbreviation:  Stroke     Publication Date:  2000 Apr 
Date Detail:
Created Date:  2000-04-27     Completed Date:  2000-04-27     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  915-9     Citation Subset:  IM    
Center for Noninvasive Brain Perfusion Studies, Stroke Treatment Team, University of Texas-Houston Medical School, Houston, TX 77030, USA.
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MeSH Terms
Acute Disease
Brain Ischemia / etiology,  physiopathology*,  ultrasonography*
Cerebral Angiography
Coronary Disease / complications
Disease Progression
Embolism / complications
Intracranial Arteriosclerosis / complications
Magnetic Resonance Angiography
Middle Aged
National Institutes of Health (U.S.)
Point-of-Care Systems
Prospective Studies
Severity of Illness Index
Tomography, X-Ray Computed
Ultrasonography, Doppler, Transcranial
United States
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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