Associations of clinical stroke misclassification (‘clinical-imaging dissociation’) in acute ischemic stroke
Potter, Gillian Margaret
Jackson, Caroline Anne
Wardlaw, Joanna M
MetadataShow full item record
Background: Up to 20% of lacunar infarcts are misdiagnosed as cortical infarcts clinically and vice versa. The reasons for this discrepancy are unclear. We assessed clinical and imaging features which might explain this ‘clinical-imaging dissociation’. Methods: Patients with an acute stroke syndrome (cortical or lacunar) underwent magnetic resonance imaging including diffusion-weighted imaging (DWI). We recorded DWI-positive infarcts, proximity to cortex for small subcortical infarcts. We examined factors associated with clinical-imaging dissociation. Results: 137 patients with a mild cortical or lacunar syndrome had an acute ischaemic 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 to 130.1), left hemisphere location (OR 8.95, 95% CI 1.23 to 64.99) and diabetes (OR 17.1, 95% CI 1.49 to 196.16) predicted clinical-imaging dissociation. On multivariate analysis of all 137 patients, clinical-imaging dissociation was associated with diabetes (OR 7.12, 95% CI 1.86 to 27.2). Conclusions: Clinical-imaging dissociation 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 minimised in research by verification with high sensitivity imaging.
Showing items related by title, author, creator and subject.
Post-stroke depression (PSD) and post-stroke emotional liability (PSEL) : a systematic review of non-pharmacological interventions for PSD, and a qualitative study of specialist professionals' conceptualisation of PSEL Picton, Hannah Kathryn (The University of Edinburgh, 2014-07-01)Aims: a review of the literature on non-pharmacological interventions for post-stroke depression (PSD) was completed with the aim of examining issues regarding the design and methodology of trials for non-pharmacological ...
Doubal, Fergus Neil (The University of Edinburgh, 2011-07-05)Background. Lacunar strokes account for 25% of all ischaemic stroke but the exact nature of the causative cerebral small vessel abnormality remains unknown. Pathological studies are technically difficult and brain imaging ...
Doubal, F.N.; de Haan, R; MacGillivray, T.J.; Cohn-Hokke, P.; Dhillon, B.; Dennis, M.S.; Wardlaw, J.M. (John Wiley & Sons, 2010-12)Background. Cerebral small vessel disease (lacunar stroke and cerebral white matter hyperintensities) is caused by vessel abnormalities of unknown aetiology. Retinal vessels show developmental and pathophysiological ...