The clinical–DWI mismatch

Abstract

Acute stroke patients with an NIHSS score of > or =8 and DWI volume of < or =25 mL have a higher probability of infarct growth and early neurologic deterioration. The new concept of CDM may identify patients with tissue at risk of infarction for thrombolytic or neuroprotective drugs.

Late Endovascular Revascularization in Acute Ischemic Stroke Based on Clinical-Diffusion Mismatch

“…First, not all the patients by protocol underwent follow-up MR imaging or CT at a prespecified time point, making it difficult to comment on infarct expansion, a main study outcome in the articles of Davalos et al 10 and Prosser et al 11 These studies also used volumetric analysis to quantify the area of DWI involvement. Due to above-cited reasons, we used crude methods for measurement.…”

“…In 2 large natural history studies, 10,11 a clinical-diffusion mismatch (CDM) of an initial National Institutes of Health Stroke Scale (NIHSS) score Ն8 and a baseline DWI MR imaging lesion volume Յ25 mL identified a stroke subpopulation with increased rates of subsequent infarct expansion and early neurologic deterioration (END), defined as an increase in the NIHSS score of Ն4 points at 72 hours. 10 This worsening was greatest among patients with CDM who did not receive reperfusion therapy.…”

“…10 This worsening was greatest among patients with CDM who did not receive reperfusion therapy. 10 An additional study applying the Alberta Stroke Program Early CT Score (ASPECTS) 12 to brain DWI of patients presenting within 24 hours of nonlacunar anterior circulation strokes also demonstrated a similar phenomenon of END and infarct expansion among patients with ASPECTS Ն8 and NIHSS score Ն8.…”

“…10 This worsening was greatest among patients with CDM who did not receive reperfusion therapy. 10 An additional study applying the Alberta Stroke Program Early CT Score (ASPECTS) 12 to brain DWI of patients presenting within 24 hours of nonlacunar anterior circulation strokes also demonstrated a similar phenomenon of END and infarct expansion among patients with ASPECTS Ն8 and NIHSS score Ն8. 13 We sought to study the rates of END and early neurologic improvement (ENI, decrease in NIHSS score of Ն4 points) at 7-10 days in a consecutive series of patients with CDM with AIS beyond 8 hours considered for endovascular revascularization therapy.…”

Refining the Mismatch Concept in Acute Stroke: Lessons Learned from PET and MRI

“…The clinical/DWI mismatch combines the clinical stroke severity with the size of the DWI lesion to estimate the amount of mismatch (Davalos et al, 2004). The clinical deficit results from tissue impairment within either the mismatch or the infarct core.…”