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BACKGROUND: The early correct diagnosis of acute cerebral infarction (ACI) is very important for choosing therapeutic regimen. The classification of Oxfordshire community stroke project (OCSP) provides guide for easy and rapid diagnosis and choosing therapeutic regimen in clinical practice. But current operation is not satisfied. Only depending on clinical symptoms and body signs do objective evidences lack. Transcranial Doppler ultrasound (TCD) examination may provide hemodynamical evidences for the correct classification of OCSP to some extent. OBJECTIVE: To compare the results of OCSP classification and TCD examination for treating ACI in patients, and analyze the relationship between them as well as the effect of TCD on the correct classification of OCSP. DESIGN: Controlled observation. SETTING: Department of Internal Medicine, Shenzhen Hospital of Prevention and Treatment for Occupational Disease. PARTICIPANTS: Thirty-eight inpatients with ACI including 21 males and 17 females, aged 50 to 81 years, who received treatment in the Department of Internal Medicine, Shenzhen Hospital of Prevention and Treatment for Occupational Disease within 24 hours after onset from October 2002 to October 2005 were involved. The involved inpatients all confirmed to the diagnostic criteria of ACI formulated in the 4th National Cerebrovascular Diseases Conference. All the cases received skull computer tomography (CT) or magnetic resonance imaging (MRI) examinations at 24 hours after onset. Those patients who had no obvious infarct focus in skull CT examination within 24 hours after onset were performed re-examination to verify ACI within 72 hours after onset. Informed consents of examination method were obtained from all the patients. METHODS: According to the classification of OCSP, the patients were assigned into 4 subtypes: lacunar infarction (LACI), total anterior circulation infarction (TACI), part anterior circulation infarction (PACI) and posterior circulation infarction (POCI). The mean velocity of blood flow of bilateral middle cerebral artery (MCA), anterior cerebral artery (ACA), posterior cerebral artery (PCA), vertebral artery (VA) and basal artery (BA) were routinely detected through temporal window and occipital window respectively by using 2 MHz detecting head of transcranial Doppler (BMS-9000, USA) at 24 hours after onset. The rate of abnormal velocity of blood flow in each vessel of each type was calculated. The normal velocity of blood flow diagnosed by TCD was 45-75 cm/s in MCA,40-65 cm/s in ACA,30-50 cm/s in PCA,25-45 cm/s in BA and 20-35 cm/s in VA. MAIN OUTCOME MEASURES: TCD examination results of different OSCP classification in patients. RESULTS: In the group of TACI, the signal of blood flow could not be detected in 3 vessels of MCA and 1 vessel of ACA. The sequence of percentage of abnormality of the mean velocity of blood flow was MCA (100%),ACA (85.7%),PCA (71.4%),VA (62.5%)and BA (57.5%). In the group of PACI, the signal of blood flow could not be detected in 3 vessels of ACA, and sequence of percentage of abnormality of the mean velocity of blood flow was MCA (90.9%), ACA (72.7%), BA (53.8%), VA (46.1%) and PCA (45.5%). In the group of POCI, the signal of blood flow could not be detected in 2 vessels of VA and 1 vessel of BA, and the sequence of percentage of abnormality of the mean velocity of blood flow was PCA and BA (100%), VA (80%), MCA (75%) and ACA(62.5%). In the group of LACI, the signal of blood flow could be detected in all the vessels , and the sequence of percentage of abnormality of the mean velocity of blood flow was MCA (63.6%), ACA (54.5%), BA(50%), VA (33.3%) and PCA (31.8%). CONCLUSION: ① Four subtypes of OSCP have characteristic differences, which reflect the main vessels affected by the abnormality of hemodynamics of each subtype, in detecting ACI with TCD examiniation. ② Early TCD examination of ACI in patients has certain reference value for assisting the classification of OCSP.
BACKGROUND: The early correct diagnosis of acute cerebral infarction (ACI) is very important for choosing therapeutic regimen in clinical practice. The classification of Oxfordshire community stroke project (OCSP) provides guide for easy and rapid diagnosis and choosing therapeutic regimen in clinical practice. not satisfied. Only depends on clinical symptoms and body signs do objective evidences lack. Transcranial Doppler ultrasound (TCD) examination may provide hemodynamical evidences for the correct classification of OCSP to some extent. OBJECTIVE: To compare the results of OCSP classification and TCD examination for treating ACI in patients, and analyzing the relationship between them as well as the effect of TCD on the correct classification of OCSP. DESIGN: Controlled observation. SETTING: Department of Internal Medicine, Shenzhen Hospital of Prevention and Treatment for Occupational Disease. PARTICIPANTS: Thirty -eight in patients with ACI including 21 males and 17 females, ag ed 50 to 81 years, who received treatment in the Department of Internal Medicine, Shenzhen Hospital of Prevention and Treatment for Occupational Disease within 24 hours after onset from October 2002 to October 2005 were involved. The involved in patients all confirmed to the diagnostic criteria of ACI formulated in the 4th National Cerebrovascular Diseases Conference. All the cases received skull computer tomography (CT) or magnetic resonance imaging (MRI) examinations at 24 hours after onset. Those patients who had no obvious infarct focus in skull CT examination within 24 hours after onset METHODS: According to the classification of OCSP, the patients were assigned into 4 subtypes: lacunar infarction (LACI), total Anterior circulation infarction (TACI), part anterior circulation infarction (PACI) and posterior circulation infarction (POCThe mean velocity of blood flow of bilateral middle cerebral artery (MCA), anterior cerebral artery (ACA), posterior cerebral artery (PCA), vertebral artery (VA) and basal artery (BA) were routinely detected through temporal window and occipital window respectively by using 2 MHz detecting head of transcranial Doppler (BMS-9000, USA) at 24 hours after onset. The rate of abnormal velocity of blood flow in each vessel of each type was calculated. The normal velocity of blood flow diagnosed by TCD was 45-75 cm / s in MCA, 40-65 cm / s in ACA, 30-50 cm / s in PCA, 25-45 cm / s in BA and 20-35 cm / s in VA. MAIN OUTCOME MEASURES : TCD examination results of different OSCP classification in patients. RESULTS: In the group of TACI, the signal of blood flow could not be detected in 3 vessels of MCA and 1 vessel of ACA. The sequence of percentage of abnormality of the mean velocity of The flow of MCA was 100%, ACA was 85.7%, PCA was 71.4%, VA was 62.5% and BA was 57.5%. In the group of PACI, the signal of blood flo w could not be detected in 3 vessels of ACA, and sequence of percentage of abnormality of the mean velocity of blood flow was MCA (90.9%), ACA (72.7%), BA (53.8%), VA (45.5%) In the group of POCI, the signal of blood flow could not be detected in 2 vessels of VA and 1 vessel of BA, and the sequence of percentage of abnormality of the mean velocity of blood flow was PCA and BA ( 100%), VA (80%), MCA (75%) and ACA (62.5%). In the group of LACI, the signal of blood flow could be detected in all the vessels, and the sequence of percentage of abnormality of the Mean velocity of blood flow was MCA (63.6%), ACA (54.5%), BA (50%), VA (33.3%) and PCA (31.8%). CONCLUSION: main vessels affected by the abnormality of hemodynamics of each subtype, in detecting ACI with TCD examiniation. ② Early TCD examination of ACI in patients has certain reference value for assisting the classification of OCSP.