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Serial transcranial Doppler sonography in ischemic strokes in middle cerebral artery territory
Abstract:
The changes in middle cerebral artery (MCA) blood flow velocity were serially evaluated in 31 patients with acute ischemic strokes in the MCA territory using transcranial Doppler ultrasound. In patients with a poor clinical prognosis, MCA mean velocity on the infarcted side (MV1) was significantly decreased within 48 hours after onset, compared with that on the opposite side (MV2) (p < 0.01). However, this change was not significant in patients with a good clinical prognosis. As predictors of poor clinical prognosis, an MV1 of 40 cm/sec or less and an asymmetry index of -20% or less showed positive predictive values of 93 and 88%, with sensitivities of 72 and 83% and specificities of 92 and 85%, respectively. An MV1 slower than 20 cm/sec or an asymmetry index below -50% had a 100% positive predictive value and a 100% specificity, but less sensitivity (17 and 44%, respectively). Combining an MV1 of 40 cm/sec or less with an asymmetry index of -20% or less resulted in a 100% positive predictive value and a 100% specificity, with a relatively high sensitivity of 67%. As predictors of good clinical prognosis, an MV1 faster than 40 cm/sec and an asymmetry index above -20% showed positive predictive values of 71 and 79%, with sensitivities of 92 and 85% and specificities of 72 and 83%, respectively. The clinical prognosis based on MV1 seems particularly reliable for MCA territorial and cortical infarctions.
Insights
Reduced middle cerebral artery (MCA) blood flow velocity within 48 hours predicts poor stroke prognosis. Specific velocity thresholds and asymmetry indices accurately forecast patient outcomes in MCA ischemic stroke cases.
Area of Science:
- Neurology
- Vascular Medicine
- Medical Imaging
Background:
- Acute ischemic stroke in the middle cerebral artery (MCA) territory poses significant clinical challenges.
- Accurate prognostication is crucial for guiding patient management and treatment strategies.
Purpose of the Study:
- To evaluate the utility of middle cerebral artery (MCA) blood flow velocity changes in predicting clinical prognosis following acute ischemic stroke.
- To identify specific transcranial Doppler (TCD) ultrasound parameters indicative of stroke severity and patient outcomes.
Main Methods:
- Serial transcranial Doppler (TCD) ultrasound examinations were performed on 31 patients with acute ischemic stroke in the MCA territory.
- Middle cerebral artery (MCA) mean velocity on the infarcted side (MV1) and the opposite side (MV2) were measured and compared.
- Asymmetry index (AI) was calculated, and predictive values, sensitivities, and specificities of different MV1 and AI thresholds were assessed for predicting poor and good clinical prognosis.
Main Results:
- Significantly decreased MV1 within 48 hours post-stroke onset was observed in patients with a poor prognosis compared to controls (p < 0.01).
- MV1 ≤ 40 cm/sec and AI ≤ -20% demonstrated high positive predictive values (93% and 88%) and specificities (92% and 85%) for poor prognosis.
- Combining MV1 ≤ 40 cm/sec with AI ≤ -20% yielded 100% positive predictive value and specificity for poor prognosis, with 67% sensitivity.
Conclusions:
- MCA mean velocity (MV1) and asymmetry index (AI) are reliable predictors of clinical prognosis in patients with MCA ischemic stroke.
- Specific TCD parameters, particularly MV1 ≤ 40 cm/sec and AI ≤ -20%, can accurately identify patients with a poor prognosis.
- These findings are especially relevant for MCA territorial and cortical infarctions, aiding in clinical decision-making.