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Published on: September 25, 2019
EXPRESS: Perfusion Extent and Hypoperfusion Severity Determine Diaschisis Patterns in Acute Ischemic Stroke: A CT
Q I Jia1, Nan Nan Sheng1, Noemie Ligot1
1Neurology Department, Université Libre de Bruxelles - Cliniques Universitaires de Bruxelles - Hôpital Erasme, Bruxelles, Belgium.
Background:
Diaschisis reflects remote functional suppression following focal ischemia and large-scale network disruption. We investigate the prevalence, overlap, and determinants of multiple diaschisis subtypes using acute CTP.
Methods:
We retrospectively analyzed 659 patients with hyperacute large-vessel occlusion stroke. Diaschisis was primarily assessed on CBV maps and classified into Crossed Cerebellar (CCD), Ipsilateral Thalamic (ITD), Ipsilateral Hippocampal (IHD), and CCD+ITD. Tmax-based assessment was exploratory. Multivariable logistic regression evaluated severe hypoperfusion extent (Tmax>6s), hypoperfusion intensity ratio (HIR), and ischemic core volume (CBF<30%).
Results:
CCD was the most common subtype, followed by ITD and CCD+ITD, whereas IHD was rare. Greater severe hypoperfusion extent was independently associated with CCD, ITD, and CCD+ITD, while higher HIR was additionally associated with ITD, and CCD+ITD. Ischemic core volume was not independently associated with diaschisis. CCD was independently associated with left hemispheric stroke, while combined CCD+ITD was associated with female sex. Exploratory Tmax-based analyses showed broadly similar associations. Subtype overlap suggested involvement of multiple interconnected network nodes.
Conclusion:
Hyperacute diaschisis reflects ischemia-driven network dysfunction primarily related to severe hypoperfusion extent, with hypoperfusion severity contributing to specific subtypes. These findings support CBV-based CTP assessment for investigating large-scale network vulnerability, while Tmax-based may provide complementary information for future diaschisis research.
