Clinical-Radiological Severity Mismatch Phenomenon: Patients with Severe Neurological Deficits Without Matching Infarction on Computed Tomographic Scan

Adnan I. Qureshi, Saqib A. Chaudhry, Kamesh Sivagnanam, Gustavo J. Rodriguez, M. Fareed K. Suri, Kamakshi Lakshminarayan, Mustapha A. Ezzeddine

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objective: 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. Methods: 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. Results: 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, P= .0063) after adjusting for potential confounders. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)21-27
Number of pages7
JournalJournal of Neuroimaging
Volume23
Issue number1
DOIs
StatePublished - Jan 2013

Keywords

  • Clinical-radiological severity mismatch
  • Stroke
  • Thrombolysis

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