Hung-Ming Wu1,2, I-Hui Lee1,3, Chao-Bao Luo4,5, Chih-Ping Chung3,4,6, Yung-Yang Lin1,3,6,7,8,9. 1. Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan, Republic of China. 2. Department of Neurology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan, Republic of China. 3. Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China. 4. School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China. 5. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China. 6. Brain Research Center, National Yang-Ming University, Taipei, Taiwan, Republic of China. 7. Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China. 8. Institute of Physiology, National Yang-Ming University, Taipei, Taiwan, Republic of China. 9. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China.
Abstract
BACKGROUND: Clinical-diffusion mismatch between stroke severity and diffusion-weighted imaging lesion volume seems to identify stroke patients with penumbra. However, urgent magnetic resonance imaging is sometimes inaccessible or contraindicated. Thus, we hypothesized that using brain computed tomography (CT) to determine a baseline "clinical-CT mismatch" may also predict the responses to thrombolytic therapy. METHODS: Brain CT lesions were measured using the Alberta Stroke Program Early CT Score (ASPECTS). A total of 104 patients were included: 79 patients with a baseline National Institutes of Health Stroke Scale (NIHSS) score ≥ 8 and a CT-ASPECTS ≥ 9 who were defined as clinical-CT mismatch-positive (P group) and 25 patients with an NIHSS score ≥ 8 and a CT-ASPECTS < 9 who were defined as clinical-CT mismatch-negative (the N group). We compared their clinical outcomes, including early neurological improvement (ENI), early neurological deterioration (END), delta NIHSS score (admission NIHSS-baseline NIHSS score), symptomatic intracranial hemorrhage (sICH), mortality, and favorable outcome at 3 months. RESULTS: Patients in the P group had a greater proportion of favorable outcome at 3 months (p = 0.032) and more frequent ENI (p = 0.038) and a greater delta NIHSS score (p = 0.001), as well as a lower proportion of END (p = 0.004) than those in the N group patients. There were no significant differences in the incidence rates of sICH and mortality between the two groups. CONCLUSIONS: Clinical-CT mismatch may be able to predict which patients would benefit from intravenous thrombolysis.
BACKGROUND: Clinical-diffusion mismatch between stroke severity and diffusion-weighted imaging lesion volume seems to identify strokepatients with penumbra. However, urgent magnetic resonance imaging is sometimes inaccessible or contraindicated. Thus, we hypothesized that using brain computed tomography (CT) to determine a baseline "clinical-CT mismatch" may also predict the responses to thrombolytic therapy. METHODS: Brain CT lesions were measured using the Alberta Stroke Program Early CT Score (ASPECTS). A total of 104 patients were included: 79 patients with a baseline National Institutes of Health Stroke Scale (NIHSS) score ≥ 8 and a CT-ASPECTS ≥ 9 who were defined as clinical-CT mismatch-positive (P group) and 25 patients with an NIHSS score ≥ 8 and a CT-ASPECTS < 9 who were defined as clinical-CT mismatch-negative (the N group). We compared their clinical outcomes, including early neurological improvement (ENI), early neurological deterioration (END), delta NIHSS score (admission NIHSS-baseline NIHSS score), symptomatic intracranial hemorrhage (sICH), mortality, and favorable outcome at 3 months. RESULTS:Patients in the P group had a greater proportion of favorable outcome at 3 months (p = 0.032) and more frequent ENI (p = 0.038) and a greater delta NIHSS score (p = 0.001), as well as a lower proportion of END (p = 0.004) than those in the N group patients. There were no significant differences in the incidence rates of sICH and mortality between the two groups. CONCLUSIONS: Clinical-CT mismatch may be able to predict which patients would benefit from intravenous thrombolysis.
Authors: Srikumar B Nair; Deepthi Somarajan; Rammohan K Pillai; Keerthi Balachandran; Sona Sathian Journal: Ann Indian Acad Neurol Date: 2022-03-10 Impact factor: 1.714