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Microembolic signals and clinical outcome in patients with acute stroke--a prospective study
Abstract:
The occurrence of microembolic signals (MES) in patients with transient ischemic attack (TIA) or stroke has already been described; the influence of the time interval between onset of symptoms and transcranial Doppler monitoring (TCD) on the MES rate or MES prevalence and the possible prognostic value of the early detected MES rate on the outcome of TIA or stroke symptoms in a 3 month interval are discussed. In a prospective study we evaluated 61 patients consecutively admitted to our stroke unit after their first ischemic neurological deficit involving the vascular territory of MCA and/or ACA. All of the patients underwent a 30-minute bilateral transcranial Doppler monitoring of their MCAs for the identification of MES. Monitoring was performed 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 Barthel index (BI) and Scandinavian Stroke Scale (SSS) at the time of admission of 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 symptomatic side. The MES prevalence between both TCD monitorings was significantly different (total MES prevalence: 1st TCD: 26 patients: 2nd TCD: 13 patients; p < 0.04; ipsilateral MES prevalence: 1st TCD: 19 patients; 2nd TCD: 9 patients; p < 0.01). The regression analysis showed a significant influence of the total MES rate on both neurological scores at admission (SSS: 0.03; Barthel index: 0.04), but not for the Barthel scores after one and three months. In conclusion, we found an influence of the time interval between onset of neurological symptoms of TIA or stroke on the MES rate and the prevalence of MES. The prevalence of MES or the MES rate, found after a short 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.
Insights
Microembolic signals (MES) in stroke patients were monitored using transcranial Doppler (TCD). Early MES detection influenced initial neurological scores but did not predict long-term outcomes in this transient ischemic attack (TIA) study.
Area of Science:
- Neurology
- Vascular Neurology
- Neurosonology
Background:
- Microembolic signals (MES) are known indicators in transient ischemic attack (TIA) and stroke.
- The impact of monitoring timing on MES detection and prognostic value remains an area of investigation.
Purpose of the Study:
- To investigate the influence of the time interval between symptom onset and transcranial Doppler (TCD) monitoring on MES rate and prevalence.
- To assess the prognostic value of early detected MES on TIA or stroke outcomes over a 3-month period.
Main Methods:
- Prospective study of 61 patients admitted to a stroke unit after their first ischemic neurological deficit.
- Bilateral transcranial Doppler (TCD) monitoring of middle cerebral arteries (MCAs) for MES identification.
- Monitoring performed within 12.3 ± 9.3 hours and again at 48 hours post-stroke onset; neurological recovery assessed using Barthel index (BI) and Scandinavian Stroke Scale (SSS).
Main Results:
- 56% of patients showed MES in at least one of the two TCD registrations.
- MES prevalence differed significantly between the two monitoring sessions (p < 0.04 for total, p < 0.01 for ipsilateral).
- Early MES rate significantly influenced admission neurological scores (SSS: 0.03, BI: 0.04) but not 3-month outcomes.
Conclusions:
- The time interval between symptom onset and TCD monitoring influences MES rate and prevalence.
- Early MES detection does not appear to have prognostic value for neurological deficit outcomes at 3 months post-stroke.