Early hemodynamic changes on transcranial Doppler as a predictor of functional outcome in acute ischemic stroke: a case series from India

Abstract Background Prediction of long-term outcome in acute ischemic stroke (AIS) can impact the management and caregiver prognostication. The utility of serial transcranial Doppler (TCD) in predicting long-term disability and functional independency is uncertain. This study intended to correlate change in functional outcome in AIS with hemodynamic changes recorded by TCD. Results This was a prospective, observational, descriptive single-center study from India in AIS patients attending emergency room (ER) within 24 h after ictus. Data on sociodemographic, clinical (including NIHSS), treatment related and disability related [including modified Rankin score (mRS) and Barthel index (BI)] parameters were recorded at baseline. TCD was done at baseline and at 48 h and thrombolysis in brain ischemia (TIBI) flow grading calculated. NIHSS, mRS and BI were recorded on day 2, 30 and 90. Thirty-four patients were included and 16 (47.05%) underwent intravenous thrombolysis. Improvement in TIBI score at 48 h significantly correlated with improvement in clinical severity that is NIHSS at 48 h ( P = 0.019), irrespective of treatment received. Majority with improvement of TIBI flow grade at 48 h (80.76%), had improvement in mRS at 30 and 90 days ( P = 0.09). Similarly, this subset also had improvement in BI at 90 days ( P = 0.03). Conclusions In AIS patients, serial improvement in TCD flow significantly correlates with improvement in clinical severity and late disability and functional status irrespective of treatment.