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Early ischemic lesion recurrence within a week after acute ischemic stroke

Dong-Wha Kang1, Lawrence L Latour, Julio A Chalela

  • 1Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892-1063, USA.

Annals of Neurology
|July 3, 2003
PubMed

Insights

Multiple ischemic lesions on diffusion-weighted imaging (DWI) in acute stroke patients often indicate lesion recurrence within a week. Initial multiple DWI lesions significantly predict recurrence, suggesting prolonged ischemic risk and DWI

Area of Science:

  • Neurology
  • Radiology
  • Stroke Medicine

Background:

  • Multiple ischemic lesions on diffusion-weighted imaging (DWI) are frequently observed in acute stroke.
  • The origin of these multiple lesions, particularly within the first week, remains incompletely understood.

Purpose of the Study:

  • To investigate whether recurrence of ischemic lesions within one week of a symptomatic stroke contributes to multiple DWI findings.
  • To identify clinical and imaging predictors of lesion recurrence.

Main Methods:

  • Analysis of 99 acute ischemic stroke patients with serial DWI scans within the first week of symptom onset.
  • Definition of ischemic lesion recurrence as new lesions separate from the index lesion, with 'distant lesion recurrence' outside the initial perfusion deficit.
  • Estimation of hazard ratios (HR) for recurrence using log-rank tests.

Main Results:

  • Any lesion recurrence was observed in 34% of patients, with distant lesion recurrence in 15%.
  • Initial multiple DWI lesions were strongly associated with any recurrence (HR, 2.83) and distant recurrence (HR, 5.99).
  • Large-artery atherosclerosis was the most common stroke subtype linked to recurrence (p = 0.026).

Conclusions:

  • Multiple DWI lesions in acute stroke may reflect a prolonged period of heightened ischemic risk extending beyond the initial perfusion deficit.
  • DWI appears to be a valuable tool for assessing recurrent stroke risk in the early post-stroke period.

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