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Specific DWI lesion patterns predict prognosis after acute ischaemic stroke within the MCA territory.

Authors
Bang, OY; Lee, PH; Heo, KG; Joo, US; Yoon, SR; Kim, SY
Citation
Journal of neurology, neurosurgery, and psychiatry, 76(9):1222-1228, 2005
Journal Title
Journal of neurology, neurosurgery, and psychiatry
ISSN
0022-30501468-330X
Abstract
BACKGROUND: Apart from diffusion-weighted imaging (DWI) lesion volume and diffusion-perfusion mismatching, there is limited information about neuroradiological predictors of early prognosis after an ischaemic stroke. This study sought to identify specific DWI lesion patterns that would help prediction of early prognosis of three different endpoints: unstable hospital course, recurrence of stroke, and poor neurological outcome at 90 days after ischaemic stroke.



METHODS: A total of 426 patients with acute cerebral infarcts within the middle cerebral artery territory were prospectively studied. Using the DWI data the patients were divided into six groups (territorial, other cortical, small superficial, internal border zone, small deep, and other deep infarcts), and any recurrent strokes and prognosis over the following 90 days were recorded.



RESULTS: DWI lesion pattern was a stronger and more consistent independent outcome predictor than DWI lesion volume. The specific DWI lesion patterns associated with each endpoint differed. An unstable hospital course was frequently observed in patients with internal border zone infarcts, whereas recurrent strokes after the index stroke were commoner in those who had small superficial infarcts (p<0.05 in both cases). Similarly, poor outcome after stroke was associated with older age, severe neurological deficits at admission, and a DWI lesion pattern showing internal border zone infarcts.



CONCLUSIONS: The results of the present study indicate that the DWI lesion pattern may help in recognition of the likely differences in the early prognostic endpoints after ischaemic stroke, and DWI analysis may guide targeted interventions to prevent negative outcomes.
MeSH terms
Acute DiseaseAgedBrain Ischemia/pathology*Diffusion Magnetic Resonance ImagingFemaleHumansMaleMiddle AgedMiddle Cerebral Artery/pathology*Predictive Value of TestsPrognosisProspective StudiesRecurrenceStroke/pathology*
DOI
10.1136/jnnp.2004.059998
PMID
16107355
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Neurology
AJOU Authors
방, 오영이, 필휴
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