title: Total mismatch: negative diffusion-weighted imaging but extensive perfusion defect in acute stroke.
abstract: OBJECTIVE
  The perfusion-weighted imaging (PWI)/diffusion-weighted imaging (DWI) mismatch may identify patients who benefit from thrombolysis. However, some patients exhibit a "total mismatch," ie, negative DWI but extensive PWI defect. We aimed to assess clinical and MRI data of these patients.
  
  
  METHODS
  From June 2007 to December 2008, patients with anterior circulation ischemic stroke were evaluated for a "total mismatch" profile. MRI was performed at admission and at day 1. The score was assessed at baseline and the modified Rankin scale score was assessed at day 30.
  
  
  RESULTS
  Among 52 patients, 3 showed a total mismatch with arterial occlusion confirmed on magnetic resonance angiography. All had fluctuating symptoms (National Institutes of Health Stroke Scale scores, 0 to 10) and received intravenous tissue plasminogen activator. Day 1 DWI disclosed minimal changes in all patients. Outcome was favorable in all patients (day 30 modified Rankin scale, 0-1).
  
  
  CONCLUSIONS
  PWI may be helpful for treatment decisions in patients without DWI damage and fluctuating clinical course.
authors.forename: Tae-Hee
authors.initials: TH
authors.lastname: Cho
authors.forename: Marc
authors.initials: M
authors.lastname: Hermier
authors.forename: Josef A
authors.initials: JA
authors.lastname: Alawneh
authors.forename: Thomas
authors.initials: T
authors.lastname: Ritzenthaler
authors.forename: Virginie
authors.initials: V
authors.lastname: Desestret
authors.forename: Leif
authors.initials: L
authors.lastname: Østergaard
authors.forename: Laurent
authors.initials: L
authors.lastname: Derex
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Baron
authors.forename: Norbert
authors.initials: N
authors.lastname: Nighoghossian
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000098:blood supply / Q000473:pathology* / Q000503:physiopathology*; D002545:Brain Ischemia / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D002536:Cerebral Arteries / Q000187:drug effects / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000187:drug effects / Q000502:physiology*; D003661:Decision Support Techniques; D003951:Diagnostic Errors / Q000517:prevention & control; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy / Q000473:pathology* / Q000503:physiopathology*; D015912:Thrombolytic Therapy / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator