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From the Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA.
Dr. Yonas received a research grant from Praxair, Inc. (the distributors of Xe gas) that provides partial salary support for a research assistant in his laboratory (who was not involved in this project).
Address correspondence to Dr. Andrew D. Firlik, Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-400, Pittsburgh, PA 15213. Address reprint requests to Dr. Howard Yonas, Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-400, Pittsburgh, PA 15213.
Background and objective: Early intervention remains the key to acute ischemic stroke therapy. Many patients whose deficits would later resolve without intervention are exposed to the risks of stroke treatment without benefit. The purpose of this study was to determine whether patients with transient deficits could be distinguished from patients with evolving strokes on the basis of acute cerebral blood flow (CBF) measurements before any clinical distinction could be made.
Methods: Fifty-three patients who presented with acute hemispheric stroke symptoms and who underwent xenon-enhanced CT (XeCT) CBF studies within 8 hours of onset of symptoms (and before any clinical improvement) were studied.
Results: Eight patients (15%) had a complete resolution of their symptoms within 24 hours (not related to treatment). All eight patients with deficits that resolved had normal CBF in the symptomatic vascular territories (mean time to XeCT = 3 hours, 51 min). Mean CBF in the regions of interest of the symptomatic vascular territories of patients who had deficits that resolved was 35.4 ± 8.1 mL · 100 g-1 · min-1 compared with 17.3 ± 9.3 patients with evolving strokes (p= 0.00058).
Conclusions: Patients with ischemic neurologic deficits that will later resolve can be acutely distinguished from patients with evolving cortical infarctions using XeCT CBF measurements. CBF measurements may assist in the triage of patients for acute stroke therapy by selecting patients with a favorable prognosis and may not benefit from therapy but would still be exposed to the potential risks and expense of treatment.
Received November 21, 1997. Accepted in final form March 6, 1998.
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