Prediction of Functional Outcome and Tissue Loss in Acute Cortical Infarction

Chua, Margaret G.; Davis, Stephen M.; Infeld, Bernard; Rossiter, Stephen C.; Tress, Brian M.; Hopper, John L.

doi:10.1001/archneur.1995.00540290086022

Cited by 12 publications

(9 citation statements)

References 32 publications

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“…Several small series demonstrated no significant statistical correlation between CT lesion volume and clinical measures (BI, NIHSS, Rankin Disability Scale). 9,17,18 Other, generally larger, series did show correlations between subacute CT lesion size and clinical scales (NIHSS, Rankin Disability Scale, Oxford Disability Scale, aphasia severity scale). 7,19 -21 Compared with these earlier investigations, the RANTTAS data set is unique in size, geographic diversity, and actual participation in an acute stroke clinical trial.…”

Section: Discussionmentioning

confidence: 94%

See 1 more Smart Citation

Infarct Volume as a Surrogate or Auxiliary Outcome Measure in Ischemic Stroke Clinical Trials

Saver

Johnston

Homer³

et al. 1999

Stroke

216

148

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Section: Discussionmentioning

confidence: 94%

“…Decrease in infarct volume has been suggested as an appropriate surrogate or auxiliary outcome measure for human stroke trials. 8,9 However, few reports have analyzed correlations between infarct volume and clinical end points in stroke trial populations.…”

mentioning

confidence: 99%

Infarct Volume as a Surrogate or Auxiliary Outcome Measure in Ischemic Stroke Clinical Trials

Saver

Johnston

Homer³

et al. 1999

Stroke

216

148

View full text Add to dashboard Cite

show abstract

“…The remaining 78 references [24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100]described 68 different studies and 83 separate prognostic models. We classified the models on the basis of whether they were community or hospital-based, the pathological type of stroke included, and the type and timing of the outcome (table 2).…”

Section: Resultsmentioning

confidence: 99%

Systematic Review of Prognostic Models in Patients with Acute Stroke

Counsell

Dennis²

2001

Cerebrovasc Dis

224

211

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Prognostic models in stroke may be useful in clinical practice and research. We systematically reviewed the methodology and results of studies that have identified independent predictors of survival, independence in activities of daily living, and getting home in patients with acute stroke. Eligible studies (published in full in English) included at least 100 patients in whom at least 3 predictor variables were assessed within 30 days of stroke onset and who were followed up for at least 30 days. We recorded 25 indicators of the validity and practicality of each model and identified variables that were consistent independent predictors of each outcome. Eighty-three separate prognostic models were found but most had potentially serious deficiencies in internal and statistical validity, many had limited generalisability, and none had been adequately validated. Only 4 studies met 8 simple quality criteria. Over 150 different predictor variables have been analysed but most were assessed in only 1 or 2 models. None of the existing prognostic models have been sufficiently well developed and validated to be useful in either clinical practice or research. Better quality models must be produced to enable, for example, adequate case-mix correction when comparing outcome among different groups of stroke patients.

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“…Previous studies have examined the relationship between stroke size and clinical outcome. Studies using computed tomography to measure lesion size [5][6][7][8] have shown conflicting results. The largest such study 8 found only a modest correlation (r 2 ϭ0.3) between subacute infarct volume and the National Institutes of Health Stroke Scale (NIHSS) at 3 months.…”

mentioning

confidence: 99%

Relating MRI Changes to Motor Deficit After Ischemic Stroke by Segmentation of Functional Motor Pathways

Piñeiro

Pendlebury

Smith

et al. 2000

Stroke

113

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Background and Purpose-Infarct size on T2-weighted MRI correlates only modestly with outcome, particularly for small strokes. This may be largely because of differences in the locations of infarcts and consequently in the functional pathways that are damaged. To test this hypothesis quantitatively, we developed a "mask" of the corticospinal pathway to determine whether the extent of stroke intersection with the pathway would be more closely related to clinical motor deficit and axonal injury in the descending motor pathways than total stroke lesion volume. Methods-Eighteen patients were studied Ն1 month after first ischemic stroke that caused a motor deficit by use of brain T2-weighted imaging, MR spectroscopic (MRS) measurements of the neuronal marker compound N-acetyl aspartate in the posterior limb of the internal capsule, and motor impairment and disability measures. A corticospinal mask based on neuroanatomic landmarks was generated from a subset of the MRI data. The maximum proportion of the cross-sectional area of this mask occupied by stroke was determined for each patient after all brain images were transformed into a common stereotaxic brain space. Results-There was a significant linear relationship between the maximum proportional cross-sectional area of the corticospinal mask occupied by stroke and motor deficit (r 2 ϭ0.82, PϽ0.001), whereas the relationship between the total stroke volume and motor deficit was better described by a cubic curve (r 2 ϭ0.76, PϽ0.001). Inspection of the data plots showed that the total stroke volume discriminated poorly between smaller strokes with regard to the extent of associated motor deficit, whereas the maximum proportion of the mask cross-sectional area occupied by stroke appeared to be a more discriminatory marker of motor deficit and also N-acetyl aspartate reduction. Conclusions-Segmentation of functional motor pathways on MRI allows estimation of the extent of damage specifically to that pathway by the stroke lesion. The extent of stroke intersection with the motor pathways was more linearly related to the magnitude of motor deficit than total lesion volume and appeared to be a better discriminator between small strokes with regard to motor deficit. This emphasizes the importance of the anatomic relationship of the infarct to local structures in determining functional impairment. Prospective studies are necessary to assess whether this approach would allow improved early estimation of prognosis after stroke. (Stroke. 2000;31:672-679.)

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Prediction of Functional Outcome and Tissue Loss in Acute Cortical Infarction

Cited by 12 publications

References 32 publications

Infarct Volume as a Surrogate or Auxiliary Outcome Measure in Ischemic Stroke Clinical Trials

Infarct Volume as a Surrogate or Auxiliary Outcome Measure in Ischemic Stroke Clinical Trials

Systematic Review of Prognostic Models in Patients with Acute Stroke

Relating MRI Changes to Motor Deficit After Ischemic Stroke by Segmentation of Functional Motor Pathways

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