Prognostic Value of Doppler Ultrasound Findings in Patients with Middle Cerebral Artery Ischemic Stroke

Abstract

Background: There is still no finding available about 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. Methods: This cross-sectional study was conducted on 40 patients with acute ischemic stroke in Shafa Hospital in Kerman, Iran, 2017. All patients were admitted within 24 hours of the 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 as the massive MCA infarction (MMI), while others were excluded. In the first 24 hours, transcranial Doppler ultrasound was performed for all patients. Patients were then examined until discharge or death. In 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. Results: In the malignant cases, the mean PSV and MFV in MCA in the contralateral side of the lesion were significantly higher than those in the non-malignant cases. A significant increase in mean PSV and MFV in ACA in the contralateral side of the lesion was found in the malignant cases compared to the 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 early identification of cases that advance to malignancy