Characteristics associated with outcome in patients with first‐ever posterior fossa stroke. (25th March 2018)

• Record Type: Journal Article
• Authors: Villringer, K.; Florczak‐Rzepka, M.; Grittner, U.; Brunecker, P.; Tepe, H.; Nolte, C. H.; Fiebach, J. B.
• Is Part Of: European journal of neurology. Volume 25:Number 6(2018)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2018-03-25
• Subjects: magnetic resonance imaging -- outcome -- stroke; Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/ene.13596
• Languages: English
• ISSNs: 1351-5101

Abstract

Abstract : Background and purpose: Factors such as infarct volume, infarct location and symptom severity can considerably influence long‐term outcome in posterior fossa strokes. The decision about therapy can sometimes be complicated by discrepancies between infarct volume and clinical severity. We aimed to evaluate imaging and clinical parameters possibly influencing long‐term outcome in patients with first‐ever posterior fossa stroke. Methods: Imaging was performed on a 3‐T magnetic resonance imaging scanner. Sixty‐one of 1795 patients from the observational 1000Plus and LOBI studies (NCT00715533 and NCT02077582, clinicaltrials.org) were enrolled, meeting the inclusion criteria of first‐ever posterior fossa stroke and magnetic resonance imaging examination within 24 h after symptom onset. Infarcts were classified as belonging to a proximal, middle or distal territory location in the posterior fossa. Good outcome was defined as a modified Rankin scale score of ≤1 at 3 months. Results: The largest lesion volumes on diffusion‐weighted imaging on day 0 and fluid attenuation inversion recovery (FLAIR) on day 6 were found in the middle territory location with a median volume of 0.4 mL on diffusion‐weighted imaging and 1.0 mL on FLAIR on day 6 versus 0.1/0.3 mL in the proximal and 0.1/0.1 mL in the distal territory location of the posterior fossa, respectively. Parameters associated with poor outcome were older age ( P = 0.005), higher National Institutes of Health Stroke Scale score on admission/discharge ( P = 0.016; P = 0.001), larger lesion volumes on FLAIR on day 6 ( P = 0.013) and dysphagia ( P = 0.02). There was no significant association between infarct location and modified Rankin scale score on day 90. Conclusion: Infarct volume and clinical severity, but not infarct location, were the main contributors to poor long‐term outcome in first‐ever posterior fossa strokes.