Spontaneous reperfusion of cerebral infarcts in patients with acute stroke. Incidence, time course, and clinical outcome in the Copenhagen Stroke Study
H. S. Jorgensen, B. Sperling, H. Nakayama, H. O. Raaschou and T. S. Olsen
Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark.
OBJECTIVE: To determine the incidence, time course, and clinical importance
of spontaneous reperfusion of cerebral infarcts in patients with acute
stroke. DESIGN: Prospective, community based. SETTING: Department of
Neurology, Bispebjerg Hospital, Copenhagen, Denmark. PATIENTS: Included in
the incidence and time course study were 354 unselected patients with acute
ischemic stroke. Clinical outcome was studied in a subgroup of 36 patients
admitted on the day of stroke onset and in whom it was known whether
spontaneous reperfusion occurred within the first week after stroke onset.
MEASUREMENTS: Computed tomography and single photon emission computed
tomography, with technetium Tc 99m exametazime used as a flow tracer. The
Scandinavian Stroke Scale neurologic score was determined on admission, 1
and 2 weeks after stroke, and at discharge. RESULTS: The incidence of
spontaneous reperfusion was 77% in patients with cortical infarcts. The
frequency of reperfusion increased rapidly from zero at the time of onset
to 60% on day 7 after stroke, reaching a maximum on day 14, at which time
77% showed reperfusion. Marked clinical improvement was observed in
patients with spontaneous reperfusion (P = .001), while no improvement
occurred in patients without reperfusion. Reperfusion was not observed in
subcortical infarcts. CONCLUSIONS: The rate of spontaneous reperfusion
increases gradually with time and occurs within the first 2 weeks after
stroke onset in approximately four of five patients with cortical infarcts.
Spontaneous reperfusion seemed to improve clinical outcome.
