| Differential patterns of evolution in acute middle cerebral artery infarction with perfusion-diffusion mismatch: atherosclerotic vs. cardioembolic occlusion. | |
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MedLine Citation:
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PMID: 18692854 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: An acute perfusion-diffusion mismatch is known to be the strongest predictor of infarct growth. However, the differential patterns of clinical and radiological evolution according to stroke mechanism are unknown. METHODS: The study retrospectively reviewed consecutive patients who had 1) acute middle cerebral artery (MCA) territory infarction, 2) diffusion- and perfusion-weighted imaging (DWI and PWI) and MR angiography within 24 h of onset, and follow-up DWI 5 days later, 3) stenosis (> or =50%) or occlusion of MCA on baseline imaging, 4) a baseline PWI-DWI mismatch >20%, and 5) either atherosclerotic MCA disease (MCAD) or cardioembolism (CE). National Institutes of Health Stroke Scale (NIHSS) scores and infarct volume at baseline and 5 days were obtained. RESULTS: Of 90 patients, 52 had MCAD and 38 had CE. At baseline, CE group had more severe stroke (median NIHSS, 9 vs. 5; p=0.001) and larger infarct volume (median 8.32 cc vs. 3.0 cc; p=0.034) than MCAD group. During the 1-week period, CE group had larger infarct volume growth (median 12.85 cc vs. 3.02 cc; p=0.004) than MCAD group, although clinical improvement based on NIHSS (baseline minus 5-day) tended to be higher for CE than MCAD group (median 3 vs. 1; p=0.08). The correlation between infarct volume and NIHSS score was stronger in CE (r=0.841) compared to MCAD (r=0.582) group at 5-day. CONCLUSIONS: Substantial differences in the clinico-radiological evolution of acute ischemic stroke exist according to stroke mechanism. These data emphasize the importance of the stroke mechanism in the design of MRI-based acute stroke trials. |
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Authors:
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Hye-Jin Kim; Sung-Cheol Yun; Kyung-Hee Cho; A-Hyun Cho; Sun U Kwon; Jong S Kim; Dong-Wha Kang |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't Date: 2008-08-09 |
Journal Detail:
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Title: Journal of the neurological sciences Volume: 273 ISSN: 0022-510X ISO Abbreviation: J. Neurol. Sci. Publication Date: 2008 Oct |
Date Detail:
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Created Date: 2008-09-01 Completed Date: 2009-02-06 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0375403 Medline TA: J Neurol Sci Country: Netherlands |
Other Details:
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Languages: eng Pagination: 93-8 Citation Subset: IM |
Affiliation:
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Department of Preventive Medicine, Asan Medical Center, University of Ulsan College of Medicine, South Korea. |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Atherosclerosis / pathology* Diffusion Magnetic Resonance Imaging* / methods Female Follow-Up Studies Humans Infarction, Middle Cerebral Artery / pathology* Magnetic Resonance Imaging* / methods Male Middle Aged Severity of Illness Index Statistics as Topic Time Factors |
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