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      Combined carotid and transcranial ultrasound findings compared with clinical classification and stroke severity in acute ischemic stroke.

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          Abstract

          The aim of this study was to assess the association between cerebral hemodynamics and the clinical picture as defined by the Oxfordshire Community Stroke Project (OCSP) classification, as well as the clinical severity as defined by the National Institute of Health Stroke Scale (NIHSS) within the first 6 h of an acute middle cerebral artery (MCA) stroke onset.

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          Yield and accuracy of urgent combined carotid/transcranial ultrasound testing in acute cerebral ischemia.

          Oleg Y Chernyshev, Yasuyuki Iguchi, Sergio Calleja … (2005)
          We routinely perform an urgent bedside neurovascular ultrasound examination (NVUE) with carotid/vertebral duplex and transcranial Doppler (TCD) in patients with acute cerebral ischemia. We aimed to determine the yield and accuracy of NVUE to identify lesions amenable for interventional treatment (LAITs). NVUE was performed with portable carotid duplex and TCD using standardized fast-track ( or =50% stenoses or thrombus in the symptomatic artery. One hundred and fifty patients (70 women, mean age 66+/-15 years) underwent NVUE at median 128 minutes after symptom onset. Fifty-four patients (36%) received intravenous or intra-arterial thrombolysis (median National Institutes of Health Stroke Scale (NIHSS) score 14, range 4 to 29; 81% had NIHSS > or =10 points). NVUE demonstrated LAITs in 98% of patients eligible for thrombolysis, 76% of acute stroke patients ineligible for thrombolysis (n=63), and 42% in patients with transient ischemic attack (n=33), P<0.001. Urgent DSA was performed in 30 patients on average 230 minutes after NVUE. Compared with DSA, NVUE predicted LAIT presence with 100% sensitivity and 100% specificity, although individual accuracy parameters for TCD and carotid duplex specific to occlusion location ranged 75% to 96% because of the presence of tandem lesions and 10% rate of no temporal windows. Bedside neurovascular ultrasound examination, combining carotid/vertebral duplex with TCD yields a substantial proportion of LAITs in excellent agreement with urgent DSA.
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            Imaging-Based Decision Making in Thrombolytic Therapy for Ischemic Stroke: Present Status

            Peter Schellinger, Jochen B. Fiebach, Werner Hacke (2003)
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              The validity of a simple clinical classification of acute ischaemic stroke.

              Allison Dennis, Andrew Wardlaw, R Sellar … (1996)
              The aim of the study reported here was to test the validity of a simple clinical classification of acute ischaemic stroke (Oxfordshire Community Stroke Project, OCSP) in predicting the site and size of cerebral infarction on computed tomography (CT). Consecutive patients admitted to hospital with acute ischaemic stroke were prospectively identified and classified into one of four clinical syndromes according to the OCSP classification, blind to the result of CT. The CT brain scans were classified blind to the clinical features into those demonstrating: small, medium or large cortical infarcts; small or large subcortical infarcts in the anterior circulation territory; and posterior cerebral circulation territory infarcts. A total of 108 patients were included. A recent infarct was seen on the CT scan in 91 patients (84%), and the clinical classification correctly predicted the site and size of the cerebral infarct in 80 of these (88%; 95% confidence interval 77-92%). The positive predictive value was best for large cortical infarcts (0.94) and worst for small subcortical infarcts (0.63). The OCSP clinical classification is a reasonably valid way of predicting the site and size of cerebral infarction on CT and can, therefore, be used very early after stroke onset before the infarct appears on the scan.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): Cerebrovasc. Dis.
                Title: Cerebrovascular diseases (Basel, Switzerland)
                Publisher: S. Karger AG
                ISSN: 1015-9770
                ISSN (Print): 1015-9770
                Publication date (Electronic): 2006
                Volume: 21
                Issue: 1-2
                Affiliations
                [1 ] Department of Neurology, Haukeland University Hospital, Bergen, Norway. lars.thomassen@haukeland.no
                Article
                Publisher Item ID: 90008
                DOI: 10.1159/000090008
                PubMed ID: 16330869
                SO-VID: afde8cb0-c794-42ca-a563-0dd37c9c1cf0
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