Neurosonography—a useful bedside tool for strokologists
Original article
Malferrari G et al. (2007) The Eligible Study: ultrasound assessment in acute ischemic stroke within 3 hours. Cerebrovasc Dis 24: 469–476 PubMed
Rapid determination of the site and burden of arterial thrombi is crucial following acute stroke, as the speed of recanalization affects the individual's clinical course. Neurosonographic examinations are noninvasive, convenient to use, relatively inexpensive and can be performed at the bedside. The multicenter, observational Eligible Study has now shown that neurosonography can identify the site of clot as early as 3 h after symptom onset and monitor in real time the highly dynamic recanalization process of occluded vessels during treatment for stroke.
A total of 89 consecutive patients with stroke underwent ultrasound assessment (echo color Doppler ultrasound and transcranial color-coded duplex sonography) within 3 h of stroke onset, at 3–6 h and 24–36 h after admission, at day 5, and after 3 months. On the basis of admission ultrasound findings, patients were stratified according to vascular lesion subtype (tandem or T occlusions, middle cerebral artery stenoses or occlusions, and internal carotid artery occlusions or stenosis). The site of clot and degree of stenosis correlated highly with baseline NIH Stroke Scale score (P <0.0001); scores were highest in the patients with T or tandem occlusions (i.e. those with the greatest atherosclerotic burden). Furthermore, modified Rankin Scale score, median NIH Stroke Scale score and mortality were all significantly different between the groups at 3 months, even after adjustment for treatment. In line with previous findings, the T or tandem occlusion group had the lowest recanalization rates at 3 months and the highest mortality (50%), compared with the highest recanalization rates and no mortality in the patients with middle cerebral artery stenosis or occlusion.
These findings indicate that neurosonography could be a useful bedside tool to assess the neurovascular status in acute stroke and during treatment follow-up.
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Subject areas under which this article appears: Brain imaging | Stroke