Forty-seven patients presenting with symptoms of large middle cerebral artery territory infarcts were studied prospectively using serial CT brain scanning to assess infarct extent and swelling, and transcranial Doppler ultrasound to assess middle cerebral artery patency. The single most important determinant of cerebral infarct swelling was the extent of the infarct: the larger the infarct, the greater the amount of swelling (Spearman Rank correlation coefficient 0.74, p < 0.0001). In addition, if the blood velocity in the symptomatic middle cerebral artery did not increase in the first 5 days after symptom onset (implying no early reperfusion) the odds of severe infarct swelling were increased 7.6-fold (95% confidence interval 1.2- to 46.4-fold, 2p = 0.03), and the odds of a poor clinical outcome (dead or dependent in activities of daily living at 3 months) were increased 10-fold (95% confidence interval 2.7- to 41.6-fold, 2p = 0.0007). The only patients who recovered sufficiently to be able to return home by 3 months after stroke were amongst those whose symptomatic middle cerebral artery blood velocity increased (either spontaneously or associated with fibrinolytic or antithrombotic therapy) in the first 5 days after stroke. We conclude that early reperfusion is not associated with a worsening of acute cerebral infarct swelling, and may lead to a better clinical outcome.

Keywords:
Stroke, Transcranial Doppler, Middle cerebral artery, Cerebral oedema, Cerebral infarction, Reperfusion, CT brain scanning
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© 1993 S. Karger AG, Basel
1993
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