Clinical diagnosis of proximal occlusion of a major cerebral artery in the very early stage of ischemic stroke

Abstract

To find clinical criteria applied in the first hours of disease for the identification of severe ischemic stroke caused by an occlusion of proximal major arteries. The authors have analyzed 133 medical histories of patients with the diagnosis of acute cerebral blood circulation disorder admitted in the first 6 h from onset. All patients underwent CT-angiography or digital subtraction angiography. Occlusion of the inner carotid artery, occlusion of M1-segment of the middle cerebral artery and occlusion of a major artery were considered as proximal occlusion of major cerebral arteries. Neurological status was assessed by the signs of proximal arterial occlusion (PAO). Checking of 5 PAO symptoms allows the prediction of occlusion location in approximately 80% of cases. Presence of ≥3 out of 5 symptoms is characterized by 70% sensitivity and 90% specificity with regard to the occlusion of the inner carotid artery, M1-segment of the middle cerebral artery and/or a major artery. Predictive value of this model should be verified in a prospective study.