Predicting Early Deterioration or Improvement in Ischemic Stroke by Transcranial Doppler

To the Editor :I read with great interest the recent Stroke article by Toni and colleagues.1 In this study, early deterioration and early improvement were defined by a decrease or an increase, respectively, of 1 or more points in the Canadian Neurological Scale score from hospital admission to 48 hours after stroke onset. Among the baseline clinical characteristics, the findings from CT scans on admission, and the 6-hour transcranial Doppler (TCD) findings, only normal 6-hour TCD and abnormal 6-hour TCD were identified by logistic regression as the respective predictors of early improvement and deterioration.1 Regarding their findings and interpretations, I would like to make the following comments.First, a change of one Canadian Neurological Scale score is liable to interobserver and intraobserver variability, even though the Canadian Neurological Scale has been rigorously tested for reliability, validity, and efficiency.2 I wonder whether Toni and colleagues have tried other definitions of improvement and deterioration, such as a …