Clinical Examination Is More Predictive of Ambulation Recovery Than CT Lesion Location Following Subcortical Ischemic Stroke

Abstract

Plains, NY 10605. ' Stroke outcome predictions based on neuroimaging assessments of lesion size, cortical vs. subcortical location, or lobes involved have not been clinically useful. In order to assess the value of an "arterial distribution" outcome schema for subcortical stroke, we reviewed the CT scans of three hundred patients to find fourteen that were obtained two or more days following ischemic stroke which showed lesions restricted to either the lateral lenticulostriate (LLS) or anterior choroidal (AC) arterial distributions. Films were reviewed by two neurologists blinded to the clinical status. Motor paresis and hemisensory deficits were scored at the time of inpatient rehabilitation hospital admission by the staff neurologist having access to the CTS result but unaware of this study. Functional outcome was assessed by Life Table Analysis of the Barthel Index ambulation subscore recorded up to six months post-stroke by rehabilitation team members unaware of CT results. Of the fourteen patients, five had LLS lesions and had a 43 percent probability of becoming independent ambulators. The remaining nine had AC lesions and had a 23 percent probability of becoming independent ambulators (P = N.S., Haenszel-Mantel test). Patients with isolated motor deficits had a 70 percent probability of reaching independent ambulation vs. a 0 percent probability of independent ambulation for those with motor plus hemisensory deficits (P <0.05, Haenszel-Mantel test). These data indicate that ambulation recovery following subcortical stroke is better predicted by clinical evaluation of neurologic impairment than by CT assessment of arterial distribution affected.