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Titolo:
Diagnostic impact of early transcranial Doppler ultrasonography on the TOAST classification subtype in acute cerebral ischemia
Autore:
Wijman, CAC; McBee, NA; Keyl, PM; Varelas, PN; Williams, MA; Ulatowski, JA; Hanley, DF; Wityk, RJ; Razumovsky, AY;
Indirizzi:
Johns Hopkins Med Inst, Dept Neurol, Baltimore, MD 21205 USA Johns HopkinsMed Inst Baltimore MD USA 21205 ol, Baltimore, MD 21205 USA Johns Hopkins Med Inst, Dept Emergency Med, Baltimore, MD 21205 USA Johns Hopkins Med Inst Baltimore MD USA 21205 ed, Baltimore, MD 21205 USA
Titolo Testata:
CEREBROVASCULAR DISEASES
fascicolo: 4, volume: 11, anno: 2001,
pagine: 317 - 323
SICI:
1015-9770(2001)11:4<317:DIOETD>2.0.ZU;2-P
Fonte:
ISI
Lingua:
ENG
Soggetto:
INTERNAL CAROTID-ARTERY; STROKE REGISTRY; EMBOLIC STROKE; INFARCTION; OCCLUSION; DISEASE; ANGIOGRAPHY; ULTRASOUND; SONOGRAPHY; STENOSIS;
Keywords:
stroke subtype; transcranial Doppler ultrasonography; acute cerebral ischemia;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
38
Recensione:
Indirizzi per estratti:
Indirizzo: Wijman, CAC Univ Utrecht Hosp, Dept Neurol, Room G03-228,Heidelberglaan 100, NL-3584 CX Utrecht, Netherlands Univ Utrecht Hosp Room G03-228,Heidelberglaan 100 Utrecht Netherlands NL-3584 CX
Citazione:
C.A.C. Wijman et al., "Diagnostic impact of early transcranial Doppler ultrasonography on the TOAST classification subtype in acute cerebral ischemia", CEREB DIS, 11(4), 2001, pp. 317-323

Abstract

Objective: The impact of early transcranial Doppler ultrasonography (TCD) upon stroke subtype diagnosis is unknown and may affect therapeutic strategies. In this study, the diagnostic usefulness of TCD in stroke subtype diagnosis according to the criteria of the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) study was investigated in patients with acute cerebral ischemia. Methods: TCD examination within 24 h of symptom onset was performed in 50 consecutive patients with acute cerebral ischemia. Of these 54% were female. Sixty percent of patients were black, 36% white, and 4% Asian. Initial TOAST stroke subtype diagnosis (ITSSD) was based upon clinical presentation and initial brain imaging studies. Modified TOAST stroke subtype diagnosis was determined subsequently after additional review of the TCD examination. Final TOAST stroke subtype diagnosis was determined at hospital discharge, incorporating all diagnostic studies. Using final TOAST stroke subtype diagnosis as the 'gold standard' ITSSD and modified TOAST stroke subtype diagnosis were compared in order to determine additional benefit from the information obtained by TCD. Data were collected retrospectively by a singleinvestigate r. Results: ITSSD classified 23 of 50 (46%) patients correctly. After TCD, 30 of 50 (60%) patients were classified correctly, for an absolute benefit of 14% and a relative benefit of 30% (p = 0.018). Most benefitfrom TCD was observed in the TOAST stroke subtype category large-artery atherosclerosis, in particular in patients with intracranial vascular disease. In this category, ITSSD had a sensitivity of 27% which increased to 64% after TCD (p = 0.002). Conclusion: TCD within 24 h of symptom onset improvesthe accuracy of early stroke subtype diagnosis in patients with acute cerebral ischemia due to large-artery atherosclerosis. This may have clinical implications for early therapeutic interventions. Copyright (C) 2001 S. Karger AG, Basel.

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Documento generato il 29/03/20 alle ore 09:37:13