Ravichandran Rangaramanujanaidu, N Vasanthi, Iqbal Nayyar
General Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, IND.
General Medicine/Endocrinology, Pondicherry Institute of Medical Sciences, Pondicherry, IND.
Cureus. 2024 Jul 6;16(7):e63996. doi: 10.7759/cureus.63996. eCollection 2024 Jul.
Acute ischemic stroke causes irreversible damage to the brain parenchyma surrounded by salvageable tissue known as the ischemic penumbra. Magnetic resonance imaging (MRI), particularly the mismatch between abnormal diffusion-weighted imaging (DWI) signals and normal fluid-attenuated inversion recovery (FLAIR) signals, plays a critical role in detecting ischemic penumbra. It also allows for the identification of patients who may benefit from reperfusion therapy. Hence, this prospective cohort study aimed to explore the correlation between DWI-FLAIR mismatch and clinical outcomes in acute ischemic stroke patients, specifically those with delayed or uncertain symptom onset, offering potential insights into reperfusion therapy.
A total of 38 thrombotic stroke patients aged above 18 were included in this prospective cohort study. Baseline data, including demographics, lifestyle factors, and medical history, were recorded. DWI-FLAIR mismatch was evaluated through brain MRI within 4.5 hours to 12 hours of symptom onset.
Of the cohort, 63.2% were males, predominantly in the 61-70 age group. Smoking and alcohol consumption were reported by 15.79% each. DWI-FLAIR mismatch was present in 20 out of 38 subjects. No statistically significant differences were noted in the mean National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (MRS) scores between subjects with and without DWI-FLAIR mismatch. Thrombolysis in wake-up stroke subjects demonstrated a substantial reduction in mean MRS at discharge (1.29±0.95) and at six to eight weeks (1.71±1.11), suggesting potential benefits on functional outcomes.
The prevalence of DWI-FLAIR mismatch was seen in the majority of patients beyond their window period and also showed beneficiary outcomes with a mean reduction in NHISS and MRS scores following thrombolysis.
急性缺血性中风会对被称为缺血半暗带的可挽救组织所包围的脑实质造成不可逆损伤。磁共振成像（MRI），尤其是异常扩散加权成像（DWI）信号与正常液体衰减反转恢复（FLAIR）信号之间的不匹配，在检测缺血半暗带方面起着关键作用。它还能识别可能从再灌注治疗中获益的患者。因此，这项前瞻性队列研究旨在探讨急性缺血性中风患者，特别是症状出现延迟或不确定的患者中，DWI-FLAIR不匹配与临床结局之间的相关性，为再灌注治疗提供潜在见解。
这项前瞻性队列研究共纳入38名年龄在18岁以上的血栓性中风患者。记录了包括人口统计学、生活方式因素和病史在内的基线数据。在症状出现后4.5小时至12小时内通过脑部MRI评估DWI-FLAIR不匹配情况。
该队列中，63.2%为男性，主要集中在61-70岁年龄组。分别有15.79%的患者报告有吸烟和饮酒习惯。38名受试者中有20名存在DWI-FLAIR不匹配。有和没有DWI-FLAIR不匹配的受试者之间，平均国立卫生研究院卒中量表（NIHSS）和改良Rankin量表（MRS）评分没有统计学上的显著差异。醒后中风患者的溶栓治疗显示出院时（1.29±0.95）和六至八周时（1.71±1.11）平均MRS大幅降低，表明对功能结局有潜在益处。
大多数超出时间窗的患者存在DWI-FLAIR不匹配情况，溶栓后NHISS和MRS评分平均降低，也显示出有益的结局。
