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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
Summary
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.