Can early ischemic lesion recurrence on diffusion-weighted MRI affect functional outcome after acute ischemic stroke?
OBJECTIVE
Ischemic lesion recurrence on diffusion-weighted imaging (DWI-LR) is a frequently observed phenomenon after acute ischemic stroke. However, no study has elucidated the impact of DWI-LR on functional outcome.


METHODS
Among a consecutive series of patients who presented with focal symptoms or signs compatible with stroke within 48 hours from the onset over a 50-month period, those who had relevant ischemic lesions on initial DWI and underwent follow-up DWI within 14 days after the onset were enrolled in this study. As outcome variables, the scores on the modified Rankin Disability Scale (mRDS) at 3 months and 1 year were measured prospectively and dichotomized into good (0-2) vs. poor (3-6). When calculating odds ratios (ORs), adjustment was performed for age, previous stroke, initial score on the NIH Stroke Scale, stroke subtype, and IV thrombolysis.


RESULTS
Among those 786 patients finally enrolled in this study, 221 (28.1%) had DWI-LR. For a poor outcome at 3 months, the crude ORs of any, symptomatic, and asymptomatic DWI-LR were 2.70 [95% confidence interval (CI), 1.96 to 3.72], 10.03 (95% CI, 4.39 to 22.96), and 2.04 (95% CI, 1.44 to 2.88), respectively. With adjustment, the OR of symptomatic DWI-LR was 6.44 (95% CI, 2.50 to 16.57), whereas those of any and asymptomatic DWI-LR lost their statistical significance: 1.44 (95% CI, 0.94 to 2.20) and 1.04 (95% CI, 0.65 to 1.65), respectively. Analyzing with the 1-year outcome produced similar results.


CONCLUSIONS
This study shows that symptomatic early lesion recurrence can affect functional outcome after acute ischemic stroke, whereas an asymptomatic one may not.
Kim
Wook-Joo
WJ
Department of Neurology, Stroke Center, Seoul National University Bundang Hospital, Seongnam, Korea.
Kim
Jae Hyoung
JH
Ko
Youngchai
Y
Park
Jung Hyun
JH
Yang
Mi Hwa
MH
Jang
Myung Suk
MS
Han
Moon-Ku
MK
Kim
Sang Yun
SY
Park
Seong Ho
SH
Bae
Hee-Joon
HJ
Stroke. 2007 Mar;38(3):1091-6
17272767
Stroke. 2008 Aug;39(8):2257-63
18566302
Cerebrovasc Dis. 2000 Sep-Oct;10(5):335-51
10971019
Arch Neurol. 1998 Sep;55(9):1217-25
9740116
J Thorac Cardiovasc Surg. 2001 Jun;121(6):1150-60
11385383
Stroke. 1988 May;19(5):604-7
3363593
Stroke. 1993 Jan;24(1):35-41
7678184
Stroke. 1998 Oct;29(10):2118-24
9756592
Ann Neurol. 2003 Jul;54(1):66-74
12838521
J Neurol. 2002 Jul;249(7):888-95
12140674
Stroke. 1999 Aug;30(8):1538-41
10436097
Stat Med. 1989 Apr;8(4):431-40
2727467
Neurology. 2004 Dec 28;63(12):2261-5
15623684
Stroke. 2004 Mar;35(3):731-5
14764929
Stroke. 1994 Jul;25(7):1393-9
8023354
Lancet. 1997 May 31;349(9065):1569-81
9174558
Arch Neurol. 2001 Apr;58(4):613-7
11295992
Lancet. 2000 Apr 8;355(9211):1205-10
10770301
AJNR Am J Neuroradiol. 2001 Aug;22(7):1234-5
11498407
Stroke. 2002 Oct;33(10):2376-82
12364724
Neurology. 2005 Aug 23;65(4):513-7
16116107
Arch Neurol. 2006 Dec;63(12):1730-3
17172612
JAMA. 1998 Apr 22-29;279(16):1265-72
9565006
Neurology. 2007 Feb 6;68(6):415-9
17283315
Stroke. 2007 Nov;38(11):2919-23
17901392
Cerebrovasc Dis. 2007;24(2-3):289-95
17641485
QJM. 2006 Sep;99(9):625-33
16905751
Stroke. 1989 Aug;20(8):983-9
2756550
Stroke. 2006 Feb;37(2):577-617
16432246
Neurology. 1998 Jan;50(1):208-16
9443482
Am J Prev Med. 2006 Dec;31(6 Suppl 2):S243-5
17178312