Background: Neurovascular imaging is essential to the development of acute stroke therapies. Objective: To evaluate the sensitivity of MRI, MRA, TCD and ECCD in the early diagnosis of ischemic stroke in the anterior circulation as well as to assess the prognostic value of such tools. Methods: This study was conducted in the intensive care unit of neurology department, Zagazig university Hospitals. It included 30 patients with stroke in the carotid domain. All patients were evaluated by CANS, MRI, MRA, ECCD and TCD within the first 24 hours of stroke onset. After 48 hours they were reevaluated with CANS and TCD. Results: Eleven (36.7%) out of 30 stoke patients deteriorated in the first 48 hours and the deteriorating patients were significantly older, had more diabetes mellitus and hypertension than non deteriorating patients. Within the first 24 hours, MCA occlusion was detected in 20% patients, whereas asymmetry was present in 50% patients. After 48 hours 20% patients showed recanalizaton. Regarding ECCD, we found significant stenosis and occlusion ipsilateraly in 33.3% & 10% of patients and contralateraly in 26.7% & 3.3% of patients respectively. We found significant relations between MRI and MRA results and between TCD and MRA results. High sensitivity was detected in TCD and ECCD 90.9% for each one, whereas sensitivity of MRI and MRA was 81.8%. Conclusion: The combination of investigations; MRI, MRA, TCD, and ECCD; would provide the clinician with a powerful tool for early comprehensive assessment of stroke patients with high sensitivity and in follow up, ultrasound may be technique of choice. (Egypt J Neurol Psychiat Neurosurg. 2010; 47(2): 303-310)
Key Words: Ischemic stroke, ECCD, TCD, MRI, MRA
Correspondence to Sawsan Abdel Aziz, Department of Neurology, Zagazig University; Egypt. Tel.: +20100089860. Email: sawsan_abdelaziz@hotmail.com.