title: Clinical-radiological severity mismatch phenomenon: patients with severe neurological deficits without matching infarction on computed tomographic scan.
abstract: OBJECTIVE
  The objective was to determine the long-term outcome of patients with severe persistent neurological deficits without a large infarction on computed tomographic (CT) scan.
  
  
  METHODS
  We analyzed the prospectively collected data as part of the randomized, placebo controlled trial in patients with ischemic stroke presenting within 3 hours of symptom onset. Volume of infarction was measured from CT scan acquired at 3 months. Favorable outcome defined by no significant or slight disability on a modified Rankin scale at 12 months. We determined the outcome of patients with National Institutes of Health Stroke Scale score (NIHSS score) ≥ 10 at 24 hours.
  
  
  RESULTS
  Of the 277 patients with NIHSS score ≥ 10 at 24 hours, 88 (32%) met the criteria of clinical-radiological severity mismatch. Compared with patients with NIHSS score ≥ 10 with infarct volume ≥ 20 cc, the patients with NIHSS score ≥ 10 and infarct volume <20 cc were older but there were no differences in the gender, race or vascular risk factors. Patients with clinical-radiological severity mismatch were more likely to have a favorable outcome at 12 months compared with those without mismatch (odd ratio 4.3, 95% confidence interval 1.5-12.6, P = .0063) after adjusting for potential confounders.
  
  
  CONCLUSIONS
  We observed that approximately one-fourth of patients with severe neurological deficits have clinical-radiological severity mismatch. Such patients appear to have a high rate of favorable outcomes at 1 year.
authors.affiliation: Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, Minneapolis, MN 55455, USA. aiqureshi@hotmail.com
authors.forename: Adnan I
authors.initials: AI
authors.lastname: Qureshi
authors.forename: Saqib A
authors.initials: SA
authors.lastname: Chaudhry
authors.forename: Kamesh
authors.initials: K
authors.lastname: Sivagnanam
authors.forename: Gustavo J
authors.initials: GJ
authors.lastname: Rodriguez
authors.forename: M Fareed K
authors.initials: MF
authors.lastname: Suri
authors.forename: Kamakshi
authors.initials: K
authors.lastname: Lakshminarayan
authors.forename: Mustapha A
authors.initials: MA
authors.lastname: Ezzeddine
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002544:Cerebral Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D015990:Placebo Effect; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator