title: Significance of clinical-diffusion mismatch in hyperacute cerebral infarction.
abstract: In recent years, patient selection for intravenous tissue plasminogen activator (t-PA) therapy based on clinical-diffusion mismatch (CDM) has been closely examined. We investigated the relationship between prognosis and CDM in patients with hyperacute cerebral infarction within 3 hours of onset and compared CDM with diffusion-perfusion mismatch (DPM). Of 122 patients with hyperacute cerebral infarction who visited the hospital within 3 hours of onset between April 2007 and November 2008, 85 patients with cerebral infarction in the anterior circulation who underwent head magnetic resonance imaging diffusion-weighted imaging (DWI)/magnetic resonance angiography (MRA) (51 men and 34 women; average age, 74 ± 10 years) were enrolled. Seventeen of these patients underwent CT perfusion imaging. CDM-positive cases were those with a National Institute of Health Stroke Scale (NIHSS) score ≥ 8 and a DWI-Alberta Stroke Program Early CT Score (DWI-ASPECTS) ≥ 8; CDM-negative cases were those with an NIHSS score ≥ 8 and an ASPECTS-DWI < 8. The other patients were classified as belonging to the NIHSS score < 8 group. Of the 32 CDM-positive cases, 10 received t-PA infusion. These patients had markedly higher modified Rankin Scale scores 90 days after onset compared with the 22 patients who did not receive t-PA infusion. The 8 CDM-positive cases included 4 DPM-positive cases and 4 DPM-negative cases, and a discrepancy was confirmed between CDM and DPM. In all DPM-positive cases, MRA confirmed lesions in major intracranial arteries. CDM may enable more accurate prediction of outcomes in patients with hyperacute cerebral infarction. In addition, the combination of CDM findings and MRA findings (stenosis or occlusion in major intracranial arteries) may be an alternative to DPM for determining the indications for IV t-PA therapy in patients with hyperacute cerebral infarction.
authors.affiliation: Department of Neurology, Saitama Medical University International Medical Center, Saitama, Japan. Electronic address: ideguchi@saitama-med.ac.jp.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Deguchi
authors.affiliation: Department of Neurology, Saitama Medical University International Medical Center, Saitama, Japan.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Takeda
authors.affiliation: Department of Neurology, Saitama Medical University International Medical Center, Saitama, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Furuya
authors.affiliation: Department of Neurology, Saitama Medical University International Medical Center, Saitama, Japan.
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Hattori
authors.affiliation: Department of Neurology, Saitama Medical University International Medical Center, Saitama, Japan.
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Dembo
authors.affiliation: Department of Neurology, Saitama Medical University International Medical Center, Saitama, Japan.
authors.forename: Harumitsu
authors.initials: H
authors.lastname: Nagoya
authors.affiliation: Department of Neurology, Saitama Medical University International Medical Center, Saitama, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kato
authors.affiliation: Department of Neurology, Saitama Medical University International Medical Center, Saitama, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Fukuoka
authors.affiliation: Department of Neurology, Saitama Medical University International Medical Center, Saitama, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Maruyama
authors.affiliation: Department of Neurology, Saitama Medical University International Medical Center, Saitama, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Tanahashi
mesh_terms: D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000473:pathology; D002544:Cerebral Infarction / Q000188:drug therapy* / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D010960:Plasminogen Activators / Q000627:therapeutic use; D011379:Prognosis; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator