Total mismatch: negative diffusion-weighted imaging but extensive perfusion defect in acute stroke.
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.
Cho
Tae-Hee
TH
Hermier
Marc
M
Alawneh
Josef A
JA
Ritzenthaler
Thomas
T
Desestret
Virginie
V
Østergaard
Leif
L
Derex
Laurent
L
Baron
Jean-Claude
JC
Nighoghossian
Norbert
N
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
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator