Total mismatch: negative diffusion-weighted imaging but extensive perfusion defect in acute stroke

Stroke. 2009 Oct;40(10):3400-2. doi: 10.1161/STROKEAHA.109.563064. Epub 2009 Aug 20.

Abstract

Background and purpose: The perfusion-weighted imaging (PWI)/diffusion-weighted imaging (DWI) mismatch may identify patients who benefit from thrombolysis. However, some patients exhibit a "total mismatch," ie, negative DWI but extensive PWI defect. We aimed to assess clinical and MRI data of these patients.

Methods: From June 2007 to December 2008, patients with anterior circulation ischemic stroke were evaluated for a "total mismatch" profile. MRI was performed at admission and at day 1. The score was assessed at baseline and the modified Rankin scale score was assessed at day 30.

Results: Among 52 patients, 3 showed a total mismatch with arterial occlusion confirmed on magnetic resonance angiography. All had fluctuating symptoms (National Institutes of Health Stroke Scale scores, 0 to 10) and received intravenous tissue plasminogen activator. Day 1 DWI disclosed minimal changes in all patients. Outcome was favorable in all patients (day 30 modified Rankin scale, 0-1).

Conclusion: PWI may be helpful for treatment decisions in patients without DWI damage and fluctuating clinical course.

Publication types

  • Letter
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Brain / blood supply
  • Brain / pathology*
  • Brain / physiopathology*
  • Brain Ischemia / drug therapy
  • Brain Ischemia / pathology
  • Brain Ischemia / physiopathology
  • Cerebral Arteries / drug effects
  • Cerebral Arteries / physiopathology
  • Cerebrovascular Circulation / drug effects
  • Cerebrovascular Circulation / physiology*
  • Decision Support Techniques
  • Diagnostic Errors / prevention & control
  • Diffusion Magnetic Resonance Imaging / methods*
  • Female
  • Fibrinolytic Agents / administration & dosage
  • Hemodynamics / drug effects
  • Hemodynamics / physiology
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Stroke / drug therapy
  • Stroke / pathology*
  • Stroke / physiopathology*
  • Thrombolytic Therapy / methods
  • Tissue Plasminogen Activator / administration & dosage
  • Treatment Outcome

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator