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Incidence, Time Course, and Clinical Outcome in the Copenhagen Stroke Study

Henrik Stig Jørgensen, MD; Bjørn Sperling, MD; Hirofumi Nakayama, MD; Hans Otto Raaschou, MD; Tom Skyhøj Olsen, MD, PhD

Arch Neurol. 1994;51(9):865-873.

Abstract
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.

Author Affiliations
From the Departments of Neurology (Drs Jørgensen, Nakayama, and Olsen), Clinical Physiology/Nuclear Medicine (Dr Sperling), and Radiology (Dr Raaschou), Bispebjerg Hospital, Copenhagen, Denmark.

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