Mild neurological symptoms despite middle cerebral artery occlusion.
Coutts SB., Barber PA., Demchuk AM., Hill MD., Pexman JH., Hudon ME., Buchan AM.
BACKGROUND AND PURPOSE: Only a small percentage of stroke patients are treated with thrombolytic therapy. We sought to determine whether vessel occlusion in mild strokes represented a new target population for interventional therapy. METHODS: We imaged 106 acute stroke patients with MRI. Patients were identified with evidence of middle cerebral artery (MCA) occlusion and mild or no stroke signs (National Institutes of Health Stroke Scale [NIHSS] <or=3). They were compared with patients with signs of stroke, NIHSS >3, and MCA occlusion. RESULTS: We identified 5 patients with absent flow on MRA in the MCA and mild or no stroke signs (NIHSS <or=3). All 5 were functionally independent at 3 months. CONCLUSIONS: Caution should be exercised in considering thrombolytic therapy in these patients. Quantification of perfusion imaging is required to identify "at risk" mild stroke populations.