Clinical characteristics of unknown symptom onset stroke patients with and without diffusion-weighted imaging and fluid-attenuated inversion recovery mismatch

Thomalla, G. et al. (2018) Clinical characteristics of unknown symptom onset stroke patients with and without diffusion-weighted imaging and fluid-attenuated inversion recovery mismatch. International Journal of Stroke, 13(1), pp. 66-73. (doi:10.1177/1747493017706245) (PMID:28425349)

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Abstract

Background: Diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) mismatch was suggested to identify stroke patients with unknown time of symptom onset likely to be within the time window for thrombolysis. Aims: We aimed to study clinical characteristics associated with DWI-FLAIR mismatch in patients with unknown onset stroke. Methods: We analyzed baseline MRI and clinical data from patients with acute ischemic stroke proven by DWI from WAKE-UP, an investigator-initiated, randomized, placebo-controlled trial of MRI-based thrombolysis in stroke patients with unknown time of symptom onset. Clinical characteristics were compared between patients with and without DWI-FLAIR mismatch. Results: Of 699 patients included, 418 (59.8%) presented with DWI-FLAIR mismatch. A shorter delay between last seen well and symptom recognition (p = 0.0063), a shorter delay between symptom recognition and arrival at hospital (p = 0.0025), and history of atrial fibrillation (p = 0.19) were predictors of DWI-FLAIR mismatch in multivariate analysis. All other characteristics were comparable between groups. Conclusions: There are only minor differences in measured clinical characteristics between unknown symptom onset stroke patients with and without DWI-FLAIR mismatch. DWI-FLAIR mismatch as an indicator of stroke onset within 4.5 h shows no relevant association with commonly collected clinical characteristics of stroke patients.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Muir, Professor Keith and Ford, Professor Ian
Authors: Thomalla, G., Boutitie, F., Fiebach, J. B., Simonsen, C. Z., Pedraza, S., Lemmens, R., Nighoghossian, N., Roy, P., Muir, K. W., Ebinger, M., Ford, I., Cheng, B., Galinovic, I., Cho, T.-H., Puig, J., Thijs, V., Endres, M., Fiehler, J., and Gerloff, C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > Institute of Neuroscience and Psychology
Journal Name:International Journal of Stroke
Publisher:SAGE
ISSN:1747-4930
ISSN (Online):1747-4949
Published Online:20 April 2017
Copyright Holders:Copyright © 2017 World Stroke Organization
First Published:First published in International Journal of Stroke 13(1): 66-73
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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