Perfusion Defect and initial clinical status might predict the poor prognosis of DWI-negative ischemic stroke

초록

Purpose : The diffusion-weighted image (DWI) is a sensitive tool for diagnosing acute ischemic stroke. However, clinically acute stroke is not always accompanied by positive DWI lesion. In this diffusion negative ischemic stroke (DNIS), the clinical prognosis would be difficult to predict. We investigated which factors are associated with the clinical course in the DNIS. Methods : We retrospectively reviewed data from prospectively collected Inha university hospital stroke registry. We recruited the patients, who admitted from January 2007 to December, 2010. We identified and divided the DNIS into two groups, according to the persistence of symptoms after seven days, and analyzed the differences in clinical and imaging factors between two groups. Results : A total of 1398 subjects were enrolled and 142 DNCI patients were identified. Compared to the diffusion positive ischemic stroke group, the patients with DNIS were younger, and had the low frequency of atrial fibrillation and hypertension. Among them, 81 patients had no symptoms after 7days from onset. Compared to the 61 patients with persistent symptoms, ABCD2 score, NIHSS on admission, and the frequency of perfusion delay on perfusion MRI were lower, and the interval between onset and DWI was longer in the patients with fully recovery. Among symptoms, hemiparesis seems to be more persistent. In the multivariable analysis, initial NIHSS(≥1) and perfusion delay were independently associated with persistent symptoms (NIHSS, p<0.001, OR 17.2, 95%CI 5.5~54.0; perfusion delay, p=0.03, OR 36.7, 95%CI 1.4~977.0). Conclusions : Our results suggested that the perfusion defect and focal neurological deficit might be related to the symptom persistence in the DNIS.