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Clinical-diffusion mismatch defined by NIHSS and ASPECTS in non-lacunar anterior circulation infarction

H Tei1, S Uchiyama, T Usui

  • 1Department of Neurology, Toda Central General Hospital, 1-19-3 Hon-cho, Toda City, Saitama, 3350023, and Neurological Institute, Tokyo Women's Medical University, Japan. hideaki-tei@m5.dion.ne.jp

Journal of Neurology
|March 9, 2007
PubMed
Abstract

Insights

Clinical-DWI mismatch (CDM) in acute ischemic stroke indicates a higher risk of early neurological deterioration and lesion growth. This marker may help identify patients with brain tissue at risk of infarction, though further research is needed for clinical application.

Area of Science:

  • Neurology
  • Radiology
  • Stroke Medicine

Background:

  • Clinical-DWI mismatch (CDM) is a novel marker for brain tissue at risk in acute ischemic stroke.
  • The Alberta Stroke Program Early CT Score (ASPECTS) is used to assess early ischemic changes.

Purpose of the Study:

  • To investigate the utility of CDM, defined by the NIH Stroke Scale (NIHSS) and ASPECTS, in patients with non-lacunar anterior circulation infarction.
  • To evaluate CDM's association with early neurological deterioration (END) and lesion growth.

Main Methods:

  • Eighty-seven patients with acute ischemic stroke within 24 hours were enrolled.
  • CDM was defined as NIHSS score ≥ 8 and DWI-ASPECTS ≥ 8.
  • Patients were divided into CDM-positive and CDM-negative groups for comparison.

Main Results:

  • 40.2% of patients were CDM-positive and showed a higher risk of END (37.1% vs 13.5%).
  • Lesion growth, indicated by a ≥ 2-point decrease in ASPECTS, accompanied END in CDM-positive patients.
  • CDM was not an independent predictor of END in multiple logistic regression analysis.

Conclusions:

  • CDM identifies patients with acute ischemic stroke at high risk for early neurological deterioration and lesion growth.
  • CDM, defined by NIHSS and DWI-ASPECTS, may serve as a marker for identifying tissue at risk of infarction.
  • Further research is required to establish the clinical utility of this CDM definition in acute stroke management.

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