Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Paper Cerebrovasc Dis 2006;21:86–90 DOI: 10.1159/000090008 Combined Carotid and Transcranial Ultrasound Findings Compared with Clinical Classification and Stroke Severity in Acute Ischemic Stroke Lars Thomassen a Ulrike Waje-Andreassen a Halvor Naess a Jan Aarseth a David Russell b Departments of Neurology, a Haukeland University Hospital, Bergen, and b The National Hospital, University of Oslo, Oslo, Norway distal MCA 2 occlusion suitable for thrombolysis. Conclu- sions: Neither the OCSP classification nor the NIHSS grading provided reliable information about the site or presence of intracranial arterial occlusion in acute stroke within the first 6 h after stroke onset in the individual pa- tient. The results of this study strongly suggest that se- lection of acute ischemic stroke patients for thromboly- sis should also include an assessment of cerebral hemodynamics. Copyright © 2006 S. Karger AG, Basel Introduction It has been suggested that the simple clinical Oxford- shire Community Stroke Project (OCSP) classification may be applied as a guide to the site and probability of intracranial arterial occlusion and provide useful, robust information to guide patient management [1, 2]. Al- though there is a relationship in late assessments during the first days [1, 2], it is uncertain whether an arterial oc- clusion in the individual patient can be accurately diag- nosed on clinical grounds alone during the first 6 h [3, 4]. Transcranial Doppler (TCD) has been shown to be accu- rate in defining vascular pathology in acute ischemic stroke [5–7] and useful in patient management and deci- Key Words Stroke  Neurovascular ultrasound  OCSP Abstract Background: The aim of this study was to assess the as- sociation between cerebral hemodynamics and the clin- ical picture as defined by the Oxfordshire Community Stroke Project (OCSP) classification, as well as the clini- cal severity as defined by the National Institute of Health Stroke Scale (NIHSS) within the first 6 h of an acute mid- dle cerebral artery (MCA) stroke onset. Methods: 70 un- selected patients were grouped according to the OCSP classification and NIHSS. All patients immediately had extracranial and transcranial Doppler (TCD) ultrasound examinations. Results: In the study population as a whole, there was a significant association between intra- cranial vascular pathology and the OCSP classification (p ! 0.001) as well as the NIHSS score (p ! 0.001). In pa- tients with severe stroke, however, TCD demonstrated the hypothesized proximal MCA 1 occlusion in only 34% of patients with an OCSP-defined total anterior circula- tion syndrome and in 42% of patients with an NIHSS score of 6 15. In moderate stroke, the OCSP classification was misleading in almost half of the patients with a par- tial anterior circulation syndrome, i.e. a hypothesized Received: June 23, 2005 Accepted: September 8, 2005 Published online: November 28, 2005 Lars Thomassen Department of Neurology, Haukeland University Hospital NO–5021 Bergen (Norway) Tel. +47 55 975000, Fax +47 55 975061 E-Mail lars.thomassen@haukeland.no © 2006 S. Karger AG, Basel 1015–9770/06/0212–0086$23.50/0 Accessible online at: www.karger.com/ced