Clinical–Radiological Severity Mismatch Phenomenon: Patients with Severe Neurological Deficits Without Matching Infarction on Computed Tomographic Scan. Issue 1 (10th December 2012)

• Record Type: Journal Article
• Authors: Qureshi, Adnan I.; Chaudhry, Saqib A.; Sivagnanam, Kamesh; Rodriguez, Gustavo J.; Suri, M. Fareed K.; Lakshminarayan, Kamakshi; Ezzeddine, Mustapha A.
• Is Part Of: Journal of neuroimaging. Volume 23:Issue 1(2013)
• Page Start: 21
• Page End: 27
• Publication Date: 2012-12-10
• Subjects: Diagnostic imaging -- Periodicals; Nervous system -- Diseases -- Diagnosis -- Periodicals; Imagerie pour le diagnostic -- Périodiques; Système nerveux -- Maladies -- Diagnostic -- Périodiques; Imagerie médicale; Neuroimagerie; Neurologie; Système nerveux; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.804754
• DOI: 10.1111/j.1552-6569.2012.00737.x
• Languages: English
• ISSNs: 1051-2284

Abstract

<abstract abstract-type="main" xml:lang="en"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="abs1-1" sec-type="section"> <title>ABSTRACT</title> </sec> <sec id="abs1-2" sec-type="section"> <title>OBJECTIVE</title> <p>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.</p> </sec> <sec id="abs1-3" sec-type="section"> <title>METHODS</title> <p>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.</p> </sec> <sec id="abs1-4" sec-type="section"> <title>RESULTS</title> <p>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, <italic>P</italic>= .0063) after adjusting for potential confounders.</p> </sec> <sec id="abs1-5" sec-type="section"> <title>CONCLUSIONS</title> <p>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.</p> </sec> </abstract>