Dorte Phillip, Henrik W Schytz, Helle K Iversen, Juliette Selb, David A Boas and Messoud Ashina
Background and purpose: Continuous wave near infrared spectroscopy (NIRS) is a non-invasive bed-side optical method to detect changes in oxygenated (oxyHb) and deoxygenated hemoglobin (deoxyHb) in the outermost layers of the cerebral cortex. Cortical oxyHb low frequency oscillations (LFOs) in the 0.09-0.11 Hz range are affected by changes in cerebral autoregulation (CA), which is altered following stroke. We examined oxyHb LFOs at bed-side as a marker of CA in the subacute phase in stroke patients with or without recombinant tissue plasminogen activator thrombolytic therapy. Methods: We recruited 29 patients admitted to the stroke unit with symptoms of ischemic stroke. 11/29 patients received thrombolytic therapy. NIRS examination was conducted 2 days (median time) from stroke onset. NIRS optodes were placed on each side of the head with a 3 cm source-detector distance. Using transfer function analysis, inter-hemispheric phase shift and amplitude ratio of the oxyHb oscillations in the 0.09-0.11 Hz range were assessed. Results: The correlation between NIHSS scores at admission and oxyHb parameters revealed a significant positive correlation between stroke severity at admission and inter-hemispheric phase shift (P=0.028). The oxyHb absolute inter-hemispheric phase shift was significantly less in patients receiving thrombolytic therapy compared to non-thrombolytic therapy patients (3° vs. 23°, P=0.005). Conclusions: Stroke severity correlates with the degree of impaired cortical CA and stroke patients receiving thrombolytic therapy might have less severely impaired CA. NIRS detects alteration in cortical oxyHb LFOs between hemispheres in stroke patients in the subacute phase and may be a feasible method to explore changes at bed-side in a stroke unit.
