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October2013 Vol.50 Issue:        4        Table of Contents
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Clinical, Laboratory, and Imaging Characteristics of Strokes with Clinical Diffusion Mismatch

Ali S. Shalash, Hala M. El-Khawas, Mohammed A. Tork

Department of Neurology, Ain Shams University; Egypt



ABSTRACT

Background: The clinical-diffusion mismatch (CDM) model has been proposed as a simpler tool than perfusion-diffusion mismatch (PDM) to identify penumbral lesions in acute ischemic strokes. Objective: The present study applies the CDM concept to investigate the characteristics of the CDM lesions. Methods: Out of 324 consecutive acute ischemic stroke patients admitted within 24 hours of onset, 140 patients with non-lacunar anterior circulation strokes were enrolled where 75 patients in CDM-positive (CDM-P) group defined by NIHSS ≥8 and stroke volume ≤25 ml and >1.5 ml, while CDM-negative (CDM-N) group included 65 patients with non-lacunar anterior circulation infarctions with NIHSS ≥8 and stroke volume >25 ml. All patients underwent clinical evaluation, NIHSS scoring, MRI brain with MRA, CT brain within one week for detection of hemorrhagic transformation, and laboratory investigations. Results: both groups were comparable regarding demographic data and risk factors. However, CDM-P patients were of significantly smaller volume (p<0.000), lower NIHSS (p<0.000), while CDM-N patients were of higher incidence of embolic strokes (p=0.000), and early signs of infarction in CT (p<0.000), as well as early leucocytosis (p=0.03). CDM-P group showed fewer incidence of microbleeds (p=0.04) and hemorrhagic transformation (p<0.000), despite larger number of patients who received loading clopidogrel (p<0.01).  Conclusion: CDM-P strokes are less associated with microbleeds and less complicated by hemorrhagic transformation. CDM model is simple, easy to apply, relatively new concept that could be alternative to the more complex, time-consuming diffusion- perfusion mismatch. [Egypt J Neurol Psychiat Neurosurg.  2013; 50(4): 361-367]

Key Words: acute anterior circulation infarction, clinical-diffusion, mismatch

Correspondence to Hala M. El-Khawas, Department of Neurology, Ain Shams University, Egypt.

E-mail: halaelkhawas@hotmail.com 





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