Document Detail

"Diffusion-clinical mismatch" is associated with potential for early recovery of aphasia.
MedLine Citation:
PMID:  15753418     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Diffusion-perfusion mismatch (perfusion-weighted imaging [PWI] abnormality minus diffusion-weighted imaging [DWI] abnormality) can identify candidates for acute stroke intervention, but PWI is often not obtainable. The authors hypothesized that language tests can predict volume of hypoperfusion, and thus mismatch, in acute left hemisphere stroke, and that the estimated mismatch can predict potential for early recovery of language. METHODS: A consecutive series of 81 patients with acute left hemisphere ischemic stroke underwent language testing within 1 day of MRI scans. Volumes of abnormality on PWI and DWI were measured without knowledge of language scores. Using tests that correlated well with PWI abnormality (oral naming and repetition), the authors computed an estimated PWI abnormality (ePWI) for each patient from a linear regression model and derived a diffusion-clinical percent mismatch ([ePWI-DWI/ePWI] x 100). The authors then tested the hypothesis that patients with > or =20% diffusion-clinical mismatch have a greater chance of short-term improvement in language by examining scores of the 23 patients with repeat testing within 1 week. RESULTS: Within-group comparisons: patients with > or =20% diffusion-clinical mismatch showed improvement in total language score within 1 week (Wilcoxon signed rank: p < 0.02), whereas patients without mismatch did not. Across-group comparison: patients with > or =20% mismatch showed more short-term improvement in language scores than those without mismatch (Mann-Whitney U: p < 0.05). CONCLUSIONS: Tests of oral naming or repetition can be used in patients with acute left hemisphere stroke to estimate perfusion-weighted imaging abnormality and compute a diffusion-clinical mismatch that may predict potential for short-term language improvement.
Lora A Reineck; Sachin Agarwal; Argye E Hillis
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Neurology     Volume:  64     ISSN:  1526-632X     ISO Abbreviation:  Neurology     Publication Date:  2005 Mar 
Date Detail:
Created Date:  2005-03-08     Completed Date:  2006-02-09     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0401060     Medline TA:  Neurology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  828-33     Citation Subset:  AIM; IM    
Department of Neurology, Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA.
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MeSH Terms
Aged, 80 and over
Aphasia / diagnosis*,  etiology,  physiopathology
Brain Ischemia / diagnosis,  pathology,  physiopathology
Cerebral Arteries / physiopathology
Cerebral Cortex / blood supply,  pathology,  physiopathology
Cerebral Infarction / diagnosis*,  pathology,  physiopathology
Cerebrovascular Circulation / physiology
Diffusion Magnetic Resonance Imaging / standards*
Functional Laterality / physiology
Language Tests / standards*
Middle Aged
Predictive Value of Tests
Prospective Studies
Recovery of Function / physiology*
Time Factors
Verbal Behavior / physiology
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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