Deterioration following spontaneous improvement : Sonographic findings in patients with acutely resolving symptoms of cerebral ischemia
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...
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| Veröffentlicht in: | Stroke (1970) 2000-04, Vol.31 (4), p.915-919 |
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| container_title | Stroke (1970) |
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| creator | ALEXANDROV, A. V FELBERG, R. A DEMCHUK, A. M CHRISTOU, I BURGIN, W. S MALKOFF, M WOJNER, A. W GROTTA, J. C |
| description | 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.
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.
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 |
| doi_str_mv | 10.1161/01.STR.31.4.915 |
| format | Article |
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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.
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).
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.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/01.STR.31.4.915</identifier><identifier>PMID: 10753998</identifier><identifier>CODEN: SJCCA7</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Acute Disease ; Aged ; Biological and medical sciences ; Brain Ischemia - diagnostic imaging ; Brain Ischemia - etiology ; Brain Ischemia - physiopathology ; Cerebral Angiography ; Coronary Disease - complications ; Disease Progression ; Embolism - complications ; Female ; Humans ; Intracranial Arteriosclerosis - complications ; Magnetic Resonance Angiography ; Male ; Medical sciences ; Middle Aged ; National Institutes of Health (U.S.) ; Neurology ; Point-of-Care Systems ; Prospective Studies ; Severity of Illness Index ; Tomography, X-Ray Computed ; Ultrasonography, Doppler, Transcranial ; United States ; Vascular diseases and vascular malformations of the nervous system</subject><ispartof>Stroke (1970), 2000-04, Vol.31 (4), p.915-919</ispartof><rights>2000 INIST-CNRS</rights><rights>Copyright American Heart Association, Inc. Apr 2000</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c384t-c7b3ebd8de385cfa3a885c3161048111f67c5dd97d19451270a66b2b4b96c1e83</citedby><cites>FETCH-LOGICAL-c384t-c7b3ebd8de385cfa3a885c3161048111f67c5dd97d19451270a66b2b4b96c1e83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1326752$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10753998$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>ALEXANDROV, A. V</creatorcontrib><creatorcontrib>FELBERG, R. A</creatorcontrib><creatorcontrib>DEMCHUK, A. M</creatorcontrib><creatorcontrib>CHRISTOU, I</creatorcontrib><creatorcontrib>BURGIN, W. S</creatorcontrib><creatorcontrib>MALKOFF, M</creatorcontrib><creatorcontrib>WOJNER, A. W</creatorcontrib><creatorcontrib>GROTTA, J. C</creatorcontrib><title>Deterioration following spontaneous improvement : Sonographic findings in patients with acutely resolving symptoms of cerebral ischemia</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>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.
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.
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).
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.</description><subject>Acute Disease</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Brain Ischemia - diagnostic imaging</subject><subject>Brain Ischemia - etiology</subject><subject>Brain Ischemia - physiopathology</subject><subject>Cerebral Angiography</subject><subject>Coronary Disease - complications</subject><subject>Disease Progression</subject><subject>Embolism - complications</subject><subject>Female</subject><subject>Humans</subject><subject>Intracranial Arteriosclerosis - complications</subject><subject>Magnetic Resonance Angiography</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>National Institutes of Health (U.S.)</subject><subject>Neurology</subject><subject>Point-of-Care Systems</subject><subject>Prospective Studies</subject><subject>Severity of Illness Index</subject><subject>Tomography, X-Ray Computed</subject><subject>Ultrasonography, Doppler, Transcranial</subject><subject>United States</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkc1u3CAURlHVqJmkXXdXoarKzg7XYGO6q9K_SJEqNekaYYwzRBhcwInmCfraIZ2RWmV1N4fD_e6H0FsgNUAH5wTq65ufNYWa1QLaF2gDbcMq1jX9S7QhhIqqYUIco5OU7gghDe3bV-gYCG-pEP0G_flssok2RJVt8HgKzoUH629xWoLPypuwJmznJYZ7Mxuf8Ud8HXy4jWrZWo0n68dCF8TjpSgKkfCDzVus9JqN2-FoUnD3f427eclhTjhMWJtohqgctklvzWzVa3Q0KZfMm8M8Rb--frm5-F5d_fh2efHpqtK0Z7nSfKBmGPvRlCB6UlT1ZdJyCsJ6AJg6rttxFHwEwVpoOFFdNzQDG0SnwfT0FJ3tvSXR79WkLOeygnFuH1XyIgIKTQHfPwPvwhp92U2C4JwJ0j5B53tIx5BSNJNcop1V3Ekg8qkgSUCWgiQFyWQpqLx4d9Cuw2zG__h9IwX4cABU0spNUXlt0z-ONh0vPz8CKCObqg</recordid><startdate>20000401</startdate><enddate>20000401</enddate><creator>ALEXANDROV, A. 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V</creatorcontrib><creatorcontrib>FELBERG, R. A</creatorcontrib><creatorcontrib>DEMCHUK, A. M</creatorcontrib><creatorcontrib>CHRISTOU, I</creatorcontrib><creatorcontrib>BURGIN, W. S</creatorcontrib><creatorcontrib>MALKOFF, M</creatorcontrib><creatorcontrib>WOJNER, A. W</creatorcontrib><creatorcontrib>GROTTA, J. C</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>ALEXANDROV, A. V</au><au>FELBERG, R. A</au><au>DEMCHUK, A. M</au><au>CHRISTOU, I</au><au>BURGIN, W. S</au><au>MALKOFF, M</au><au>WOJNER, A. W</au><au>GROTTA, J. C</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Deterioration following spontaneous improvement : Sonographic findings in patients with acutely resolving symptoms of cerebral ischemia</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2000-04-01</date><risdate>2000</risdate><volume>31</volume><issue>4</issue><spage>915</spage><epage>919</epage><pages>915-919</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><coden>SJCCA7</coden><abstract>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.
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.
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).
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.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>10753998</pmid><doi>10.1161/01.STR.31.4.915</doi><tpages>5</tpages></addata></record> |
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| source | Journals@Ovid Ovid Autoload; MEDLINE; Alma/SFX Local Collection; EZB Electronic Journals Library; American Heart Association |
| subjects | Acute Disease Aged Biological and medical sciences Brain Ischemia - diagnostic imaging Brain Ischemia - etiology Brain Ischemia - physiopathology Cerebral Angiography Coronary Disease - complications Disease Progression Embolism - complications Female Humans Intracranial Arteriosclerosis - complications Magnetic Resonance Angiography Male Medical sciences Middle Aged National Institutes of Health (U.S.) Neurology Point-of-Care Systems Prospective Studies Severity of Illness Index Tomography, X-Ray Computed Ultrasonography, Doppler, Transcranial United States Vascular diseases and vascular malformations of the nervous system |
| title | Deterioration following spontaneous improvement : Sonographic findings in patients with acutely resolving symptoms of cerebral ischemia |
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