title: Intravenous thrombolysis based on diffusion-weighted imaging and fluid-attenuated inversion recovery mismatch in acute stroke patients with unknown onset time.
abstract: OBJECTIVE
  Patients with unknown onset time would be able to receive intravenous thrombolysis when showing diffusion-weighted imaging (DWI)/fluid-attenuated inversion recovery (FLAIR) mismatch.
  
  
  METHODS
  Consecutive acute stroke patients with unknown onset time were prospectively enrolled. We defined patients as having unknown onset time when the last known normal time (LNT) was not consistent with the first found abnormal time (FAT). Only patients with anterior-circulation stroke and presence of arterial lesion were enrolled. Intravenous thrombolysis was conducted within 3 h from FAT if the patient showed DWI/FLAIR mismatch.
  
  
  RESULTS
  From June 2009 to May 2010, 10 patients [median age, 84 years (interquartile range, IQR, 64-90); National Institutes of Health Stroke Scale (NIHSS) score, 14 (IQR, 9-19)] were enrolled. Subjects included 4 patients who developed stroke during sleep, 5 with disturbance of consciousness, and 1 with aphasia. Median interval between LNT and thrombolysis was 5.6 h (IQR, 4.5-9.8) and median interval between FAT and thrombolysis was 2.5 h (IQR, 2.1-2.8). Three patients had internal carotid artery occlusion, 5 had M1 occlusion, and 2 had M2 occlusion. Early recanalization within 24 h was seen in 7 patients (complete recanalization, n = 4; partial recanalization, n = 3). No patients experienced symptomatic cerebral hemorrhage within 48 h. At day 7, 5 patients showed dramatic recovery (defined as ≥ 10-point reduction in total NIHSS score or score of 0 or 1). At 3 months, favorable outcome (modified Rankin scale score, 0-2) was seen in 4 patients.
  
  
  CONCLUSIONS
  Acute stroke patients with DWI/FLAIR mismatch may be able to safely receive intravenous thrombolysis.
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Japan. aojyun@med.kawasaki-m.ac.jp
authors.forename: Junya
authors.initials: J
authors.lastname: Aoki
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Iguchi
authors.forename: Kensaku
authors.initials: K
authors.lastname: Shibazaki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Iwanaga
authors.forename: Masao
authors.initials: M
authors.lastname: Watanabe
authors.forename: Kazuto
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Sakai
authors.forename: Yuki
authors.initials: Y
authors.lastname: Sakamoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications; D002545:Brain Ischemia / Q000150:complications / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000209:etiology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D012307:Risk Factors; D012959:Socioeconomic Factors; D020521:Stroke / Q000188:drug therapy* / Q000473:pathology*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator