Early MRI and outcomes of untreated patients with mild or improving ischemic stroke.
OBJECTIVE
To determine the frequency of early neurologic deterioration with infarct expansion (ENDIE) and poor outcomes among ischemic stroke patients not treated with reperfusion therapies because of rapidly improving or mild symptoms (RIMS) and to study the predictive value of hyperacute MRI in these patients.


METHODS
We identified consecutive patients with symptoms of acute stroke undergoing multimodal MRI within 6 hours of onset without evidence of hemorrhage on imaging. Medical records were reviewed for evidence of early neurologic deterioration within 48 hours. All deteriorating patients had repeat MRI to ascertain causes of worsening. Poor outcome was defined as a discharge modified Rankin Scale (mRS) score of > or = 3.


RESULTS
We identified 74 patients with stroke symptoms < or = 6 hours from onset. Forty had RIMS, and 39 did not receive reperfusion therapies because of RIMS. Among these 39, 4 experienced ENDIE, and 8 were discharged with mRS score of > or = 3. Eight of the 39 patients had large-vessel occlusions on MR angiography. Three of 8 patients with large-vessel occlusion as against only one of 31 patients without occlusion had ENDIE (odds ratio [OR] 18, 95% CI 1.6 to 209, p = 0.02). Four of 8 patients with large-vessel occlusion as against 4 of 31 patients without occlusion had a discharge mRS score of > or = 3 (OR 7, 95% CI 1.2 to 38, p = 0.04).


CONCLUSIONS
About 10% of patients eligible for acute reperfusion therapy excluded on the basis of mild or rapidly improving symptoms show early neurologic deterioration with infarct expansion within 48 hours, and about 20% show poor outcome at discharge. Persisting large-vessel occlusion substantially increases the risk of early worsening and poor functional outcome.
Rajajee
V
V
UCLA Medical Center, Los Angeles, CA, USA. vrajajee@yahoo.com
Kidwell
C
C
Starkman
S
S
Ovbiagele
B
B
Alger
J R
JR
Villablanca
P
P
Vinuela
F
F
Duckwiler
G
G
Jahan
R
R
Fredieu
A
A
Suzuki
S
S
Saver
J L
JL
D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D020127:Recovery of Function; D015424:Reperfusion / Q000379:methods; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000503:physiopathology*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D014652:Vascular Diseases / Q000150:complications / Q000473:pathology