title: Can early ischemic lesion recurrence on diffusion-weighted MRI affect functional outcome after acute ischemic stroke?
abstract: 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.
authors.affiliation: Department of Neurology, Stroke Center, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Wook-Joo
authors.initials: WJ
authors.lastname: Kim
authors.forename: Jae Hyoung
authors.initials: JH
authors.lastname: Kim
authors.forename: Youngchai
authors.initials: Y
authors.lastname: Ko
authors.forename: Jung Hyun
authors.initials: JH
authors.lastname: Park
authors.forename: Mi Hwa
authors.initials: MH
authors.lastname: Yang
authors.forename: Myung Suk
authors.initials: MS
authors.lastname: Jang
authors.forename: Moon-Ku
authors.initials: MK
authors.lastname: Han
authors.forename: Sang Yun
authors.initials: SY
authors.lastname: Kim
authors.forename: Seong Ho
authors.initials: SH
authors.lastname: Park
authors.forename: Hee-Joon
authors.initials: HJ
authors.lastname: Bae
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