Mild neurological symptoms despite middle cerebral artery occlusion

Background and Purpose - Only a small percentage of stroke patients are treated with thrombolytic therapy. We sought to determine whether vessel occlusion in mild strokes represented a new target population for interventional therapy. Methods - We imaged 106 acute stroke patients with MRI. Patients were identified with evidence of middle cerebral artery (MCA) occlusion and mild or no stroke signs (National Institutes of Health Stroke Scale [NIHSS] less than or equal to3). They were compared with patients with signs of stroke, NIHSS >3, and MCA occlusion. Results - We identified 5 patients with absent flow on MRA in the MCA and mild or no stroke signs (NIHSS less than or equal to3). All 5 were functionally independent at 3 months. Conclusions - Caution should be exercised in considering thrombolytic therapy in these patients. Quantification of perfusion imaging is required to identify "at risk" mild stroke populations.