Prognostic value of doppler ultrasound findings in patients with middle cerebral artery Ischemic stroke

Document Type: Original Article

Authors

1 Assistant Professor of Neurology, Neurology Research Center, Kerman University of Medical Science, Kerman, Iran

2 Professor of Neurology, Neurology Research Center, Kerman University of Medical Science, Kerman, Iran

3 Professor of Neurology, Neurology Research Center, Kerman University Of Medical Science, Kerman, Iran

4 Resident of Neurology, Neurology Research Center, Kerman University Of Medical Science, Kerman, Iran

Abstract

Introduction: There is still no finding available that can show the malignant clinical course in patients with middle cerebral artery stroke. The aim of this study was to compare Doppler ultrasound findings in patients with malignant and non-malignant middle cerebral artery stroke in order to obtain its prognostic value in detecting malignant course.
Method: This cross-sectional study was conducted on 40 patients with acute ischemic stroke in Shafa University Hospital Kerman, Iran, 2017. All patients were admitted within 24 hours of onset of symptoms, and brain CT-scan was performed to confirm ischemic stroke. If more than 50% of the middle cerebral artery showed signs of hypo density, it was considered massive MCA infarction (MMI), while others were excluded. In the first 24 hours, trans cranial Doppler ultrasound was performed for all patients. Patients were then examined until discharge or death. If the case of fixed unilateral mydriasis in the clinical course or a displacement of more than 5 mm in septum pellucidum in the control CT-scan on days 3 to 7 (depending on the changes in the consciousness level), m-MCAI was diagnosed. Data were analyzed using SPSS.
Result: In the malignant cases, the mean PSV and MFV in MCA in the contralateral side of the lesion were significantly higher than the non-malignant cases. A significant increase in mean PSV and MFV in ACA in the contralateral side of the lesion was found in malignant compared to non-malignant cases (P=0.01). Significant difference was observed in terms of mean RI of ICA of contralateral side of the lesion between malignant and non-malignant cases (P=0.02).
Conclusion: Our study showed increase in PSV and MFV in MCA and ACA in the contralateral side of the lesion in cases that lead to malignancy, which can be helpful in identifying early cases that advance to malignancy.
 
 

Keywords


  1. Ropper AH, Samuels MA. Adams and Victor's Principles of Neurology. 10th ed. Philadelphia: Mc Graw Hill; 2014.
  2. Serena J, Blanco M, Castellanos M, Silva Y, Vivancos J, Moro MA, et al. The prediction of malignant cerebral infarction by molecular brain barrier disruption markers. Stroke 2005; 36(9):1921-6.
  3. Kasner SE, Demchuk AM, Berrouschot J, Schmutzhard E, Harms L, Verro P, et al. Predictors of fatal brain edema in massive hemispheric ischemic stroke. Stroke 2001; 32(9):2117-23.
  4. Dohmen C, Bosche B, Graf R, Staub F, Kracht L, Sobesky J, et al. Prediction of malignant course in MCA infarction by PET and microdialysis. Stroke 2003; 34(9):2152-8.
  5. Dohmen C, Bosche B, Graf R, Reithmeier T, Ernestus RI, Brinker G, et al. Identification and clinical impact of impaired cerebrovascular autoregulation in patients with malignant middle cerebral artery infarction. Stroke 2007; 38(1):56-61.
  6. Subramaniam S, Hill MD. Decompressive hemicraniectomy for malignant middle cerebral artery infarction: an update. Neurologist 2009; 15(4):178-84.
  7. Mayer SA. Hemicraniectomy: a second chance on life for patients with space-occupying MCA infarction. Stroke 2007; 38(9):2410-2.
  8. Lee W. General principles of carotid Doppler ultrasonography. Ultrasonography 2014; 33(1): 11–7.
  9. Schlachetzki F, Hoelscher T, Dorenbeck U, Greiffenberg B, Marienhagen J, Ullrich OW, et al. Sonographic parenchymal and brain perfusion imaging: preliminary results in four patients following decompressive surgery for malignant middle cerebral artery infarct. Ultrasound Med Biol 2001; 27(1):21-31.
  10. Nielsen TH, Ståhl N, Schalén W, Reinstrup P, Toft P, Nordström CH. Recirculation usually precedes malignant edema in middle cerebral artery infarcts. Acta Neurol Scand 2012; 126(6):404-10.
  11. Sanák D, Herzig R, Skoloudík D, Horák D, Zapletalová J, Köcher M, Kanovský P. The safety and efficacy of continuous transcranial duplex Doppler monitoring of middle cerebral artery occlusion in acute stroke patients: comparison of TCDD and thrombolysis in MCA recanalization. J Neuroimaging 2010; 20(1):58-63.
  12. Aoki J, Raber LN, Katzan IL, Hussain MS, Hui FK, Uchino K. Post-intervention TCD examination may be useful to predict outcome in acute ischemic stroke patients with successful intra-arterial intervention. J Neurol Sci 2013; 334(1-2):26-9.
  13. Perez-Nellar J, Scherle C, Machado C. TCD systolic spikes in a malignant MCA infarct. Neurocrit Care 2009; 11(1):94-6.
  14. García-Pastor A. Knowledge of vascular status for therapeutic decision-making in acute ischemic stroke: which is the role of neurosonology? Rev Neurol 2013; 56(1):35-42. Spanish
  15. Burghaus L, Hilker R, Dohmen C, Bosche B, Winhuisen L, Galldiks N, et al. Early electroencephalography in acute ischemic stroke: prediction of a malignant course? Clin Neurol Neurosurg 2007; 109(1):45-9.
  16. Shafa M, Seifaddini R, Iranmanesh F, Jafari FS. Association between Serum Uric Acid Level and Stenosis in Atherothrombotic Infarction. Journal of Kerman University of Medical Sciences 2017; 24(1): 68-77            .
  17. Oppenheim C, Samson Y, Manaï R, Lalam T, Vandamme X, Crozier S, et al. Prediction of malignant middle cerebral artery infarction by diffusion-weighted imaging. Stroke 2000; 31(9):2175-81.
  18. Wang Y, Duan YY, Zhou HY, Yuan LJ, Zhang L, Wang W, et al. Middle cerebral arterial flow changes on transcranial color and spectral Doppler sonography in patients with increased intracranial pressure. J Ultrasound Med 2014; 33(12):2131-6.
  19. Demchuk AM, Burgin WS, Christou I, Felberg RA, Barber PA, Hill MD, Alexandrov AV. Thrombolysis in brain ischemia (TIBI) transcranial Doppler flow grades predict clinical severity, early recovery, and mortality in patients treated with intravenous tissue plasminogen activator. Stroke 2001; 32(1):89-93.