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Associations of Clinical Stroke Misclassification ('Clinical-Imaging Dissociation') in Acute Ischemic Stroke

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    Rights statement: Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.

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http://www.karger.com/Article/FullText/286342
Original languageEnglish
Pages (from-to)395-402
Number of pages8
JournalCerebrovascular diseases
Volume29
Issue number4
DOIs
Publication statusPublished - 2010

Abstract

Background: Up to 20% of lacunar infarcts are clinically misdiagnosed as cortical infarcts and vice versa. The reasons for this discrepancy are unclear. We assessed clinical and imaging features which might explain this 'clinical-imaging dissociation' (C-ID). Methods: Patients with an acute stroke syndrome (cortical or lacunar) underwent magnetic resonance imaging including diffusion-weighted imaging (DWI). We recorded DWI-positive infarcts and proximity to cortex for small subcortical infarcts. We examined factors associated with C-ID. Results: 137 patients with a mild cortical or lacunar syndrome had an acute ischemic lesion on DWI. Of these, 21/93 (23%) with a cortical syndrome had an acute lacunar infarct and 7/44 (16%) with a lacunar syndrome had an acute cortical infarct. From 72 patients with an acute lacunar infarct on DWI, lesion proximity to cortex (odds ratio (OR) 14.5, 95% confidence interval (CI) 1.61-130.1), left hemisphere location (OR 8.95, 95% CI 1.23-64.99) and diabetes (OR 17.1, 95% CI 1.49-196.16) predicted C-ID. On multivariate analysis of all 137 patients, C-ID was associated with diabetes (OR 7.12, 95% CI 1.86-27.2). Conclusions: C-ID occurs in a fifth of patients with mild stroke. Lacunar infarcts lying close to cortex are more likely to cause cortical symptoms. Diabetes is associated with any clinical-imaging mismatch. Stroke misclassification which can arise with clinical classification alone should be minimized in research by verification with high-sensitivity imaging. Copyright (C) 2010 S. Karger AG, Basel

    Research areas

  • Acute ischemic stroke, Stroke subtype, Infarction, Acute stroke imaging, Diffusion-weighted imaging, DIFFUSION-WEIGHTED MRI, COMPUTED-TOMOGRAPHY, LACUNAR STROKE, PROJECT CLASSIFICATION, CEREBRAL INFARCTION, MINOR STROKE, SUBTYPES, ABNORMALITIES, BRAIN

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