الفهرس 
Patients and MethodsOnly 14 pages are availabe for public view
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Abstract
Stroke is one of the most common, fatal, and debilitating neurologic diseases. Numerous risk factors are involved in the development of stroke, affect its prognosis, and predict the outcome.
The development of transcranial color-coded duplex sonography (TCCS) has resurrected the hope of safe, real time bedside brain imaging beyond childhood’s indications. This research provides an overview of the role transcranial color-coded duplex as a predictor of early outcome in acute ischemic stroke.
This is a comparative cross-sectional study, conducted from June 2017 and it continued until December 2019 in Benha University Hospital, aimed at detection of the clinical relevance of vascular pathology assessed by TCCD, and the ability of TCCD to detect early clinical outcome in patients with acute ischemic stroke.
Study subjects were informed of the possibility of using the data obtained for academic purpose. Confidentiality was assured to all participants and data used for this study were stripped of personally identifiable information. They were also informed about their right to withdraw their consent at any point, without any consequence to them.
Study participants 50 patients with acute cerebral ischemia in the MCA (middle cerebral artery) territory and a neurological deficit lasting more than 24 hours. They were selected by considering strict inclusion and exclusion criteria. We confirmed the stroke by computed tomography (CT) brain imaging. Excluded were the patients with previous ischemic stroke, cerebral hemorrhage on CT, preexisting neurological, psychiatric, or other illnesses that would confound the neurological evaluations, severe concomitant medical condition, pregnancy, and no temporal bone window.
All patients were subjected to the following: thorough medical history taking, full general and neurological examination, ECG, complete blood count, blood sugar level, liver function test, kidney function test, and lipid profile.
Extracranial carotid artery duplex and Transcranial color duplex sonography (TCCD) were performed to all patients at day 1 and day 7.
Patients’ initial stroke severity was assessed on admission and after 7 days by the National Institutes of Health Stroke Scale (NIHSS), patients’ stroke outcome was assessed after 3 months by the Barthel ADL (activity of daily living) Index and assessment of CVS recurrence in this period.
In this study, MCA stenosis and asymmetry were significantly associated with poor outcome. Stenosis was higher in dead cases. However, normal MCA status was significantly associated with good outcome. Patients with combined MCA+ICA stenosis had significantly higher NIHSS at presentation, at follow up, significantly lower BI than separate intracranial MCA stenosis. In patients with MCA abnormalities, recanalization was significantly associated with higher improvement by NIHSS score, non-significantly associated with lower rate of 3 months CVS recurrence, and no significant association was found between MCA recanalization and BI score outcome. It was non-significantly higher in alive patients when compared to dead patients. Considering significant covariates in univariable analysis into multivariable analysis, we revealed that only hypertension, higher TC level, abnormal TCCD with intracranial stenosis and asymmetry were suggested to be predictors of poor outcome for stroked patients, with lower BI score and higher rate of CVS recurrence in 3 months.
Conclusion
We concluded the following from this study:
The presence of intracranial MCA stenosis or asymmetry is an independent predictor of poor outcome for stroked patients.
Other independent predictors for poor outcome in this study are hypertension and high total cholesterol level.
Limitations of the study:
Limitations met while conducting this study were:
• This is not a population-based study. It is a single-center case study restricted to a local hospital, based on the data collected from a small number of ethnically homogeneous, unselected clinically assessed CVIS patients, therefore may not accurately reflect most of the other population.
• The TCCD study requires a good acoustic window to identify the MCA. However, patients with older age, particularly in women, may impede the insonation of the intracranial vessels, including the MCA. Lower number of female patients in the present study may reflect a possible gender bias.
• Angiographic study was not used in this study to allow confirmation of the validity of TCCD results.
Despite these limitations, results presented here are still of value for confirming the prognostic importance of MCA stenosis for a large population of ischemic stroke patients and suggest a role for TCCD to identify this potentially important marker in patients with ischemic stroke for more assertive measures in stroke.