A Clinical Comparative And Correlative Study Of TCD, Electroneurophysiology And CT In Acute Ischemic Stroke

Objective: To investigate the cerebral hemodynamic abnormal patter and its regularity of dynamic change and the correlation with abnormality of electroneurophysiology, clinical seriousness and prognosis in acute ischemic stroke by transcranical Doppler sonography (TCD).Methods: 61 consecutive patients with a first acute ischemic stroke involving hemispheric middle cerebral artery (MCA) territory within 24h after onset were studied. All patients were dynamic evaluated by bedside TCD on 1st, 2nd, 4th, 7th, 14th, 28th day. The abnormal rate of TCD and computed tomography (CT), electroencephalography (EEG), brain electrical activity mapping (BEAM) were compared. And the correlation between TCD, EEG, BEAM, Somatosensory evoked potential (SEP), motor evoked potential (MEP), MESSS and Barthel index (BI) were studied.Results: On 1st day TCD abnormal rate was higher than CT, mean velocity of middle cerebral artery (VmMCA) of the lesion-side was lower than the contra side and the control group, mean velocity of anterior cerebral artery (VmACA) of the lesion-side was higher than the contra side and the control group. Asymmetry index (AI) of MCA on 1st day was positive correlation with MESSS on the same day and negative correlation with BI on 28th day. The abnormality of VmMCA in lesion-side on 1st day was correlated with the abnormality of EEG and BEAM, but had no correlation with the abnormality ofSEP and MEP. Dynamic study indicated that on the lesion-side, the VmMCA increased and the VmACA decreased gradually. On 2nd day the correlation between AIMCA and MESSS decreased, on other days there had no significance correlation between AIMCA and MESSS.Conclusions: TCD played a very important role on the early diagnosis in acute ischemic stroke. Dynamic study can detect 'that the occlusive artery recanalized gradually, but the MESSS did not recovered correspondingly, which suggest that the recovery of MESSS not only determined by recanalization but also influenced by metabolism and other pathophysiologic change. The abnormality of TCD was correlated with MESSS on 1st day and BI on 28th day, which proved TCD played a very important role on severity assessment and prognosis indicated in acute ischemic stroke.