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Early MRI and outcomes of untreated patients with mild or improving ischemic stroke

V Rajajee1, C Kidwell, S Starkman

  • 1UCLA Medical Center, Los Angeles, CA, USA. vrajajee@yahoo.com

Neurology
|September 27, 2006
PubMed
Abstract

Insights

Approximately 10% of ischemic stroke patients with mild or rapidly improving symptoms experience early neurologic deterioration, and 20% have poor outcomes. Large-vessel occlusions significantly increase these risks, highlighting the need for careful assessment even in seemingly mild stroke cases.

Area of Science:

  • Neurology
  • Radiology
  • Stroke Medicine

Background:

  • Ischemic stroke patients with rapidly improving or mild symptoms (RIMS) are often excluded from reperfusion therapies.
  • The risk of early neurologic deterioration with infarct expansion (ENDIE) and poor outcomes in this specific patient group is not well-defined.
  • Hyperacute magnetic resonance imaging (MRI) may offer predictive value in assessing these patients.

Purpose of the Study:

  • To determine the frequency of ENDIE and poor outcomes in ischemic stroke patients not receiving reperfusion due to RIMS.
  • To investigate the predictive value of hyperacute MRI in identifying patients at risk for ENDIE and poor outcomes.

Main Methods:

  • Consecutive acute ischemic stroke patients underwent multimodal MRI within 6 hours of symptom onset.
  • Patients were assessed for ENDIE within 48 hours, with repeat MRI for deteriorating cases.
  • Poor outcome was defined as a modified Rankin Scale (mRS) score of ≥3 at discharge.

Main Results:

  • Among 39 patients not treated with reperfusion due to RIMS, 4 experienced ENDIE, and 8 had poor outcomes (mRS ≥3).
  • Large-vessel occlusions (LVO) were present in 8 patients, significantly increasing the risk of ENDIE (OR 18) and poor outcome (OR 7) compared to those without LVO.
  • Hyperacute MRI identified LVO, a key predictor of adverse events.

Conclusions:

  • About 10% of ischemic stroke patients eligible for reperfusion but excluded due to RIMS experience ENDIE within 48 hours.
  • Approximately 20% of these patients have a poor functional outcome at discharge.
  • Persisting large-vessel occlusion is a substantial risk factor for early worsening and poor functional outcome in RIMS patients.

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