Author(s)

G. Potter, F. Doubal, C. Jackson, C. Sudlow, M. Dennis, J. Wardlaw

ISBN

1015-9770

Publication year

2010

Periodical

Cerebrovascular Diseases

Periodical Number

4

Volume

29

Pages

395-402

Author Address

Wardlaw, J Univ Edinburgh, Western Gen Hosp, Dept Clin Neurosci, SFC Brain Imaging Res Ctr, Edinburgh EH4 2XU, Midlothian, Scotland Univ Edinburgh, Western Gen Hosp, Dept Clin Neurosci, SFC Brain Imaging Res Ctr, Edinburgh EH4 2XU, Midlothian, Scotland

Full version

Background: Up to 20% of lacunar infarcts are clinically misdiagnosed as cortical infarcts and vice versa. The reasons for this discrepancy are unclear. We assessed clinical and imaging features which might explain this ‘clinical-imaging dissociation’ (C-ID). Methods: Patients with an acute stroke syndrome (cortical or lacunar) underwent magnetic resonance imaging including diffusion-weighted imaging (DWI). We recorded DWI-positive infarcts and proximity to cortex for small subcortical infarcts. We examined factors associated with C-ID. Results: 137 patients with a mild cortical or lacunar syndrome had an acute ischemic 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) 1.61-130.1), left hemisphere location (OR 8.95, 95% CI 1.23-64.99) and diabetes (OR 17.1, 95% CI 1.49-196.16) predicted C-ID. On multivariate analysis of all 137 patients, C-ID was associated with diabetes (OR 7.12, 95% CI 1.86-27.2). Conclusions: C-ID 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 minimized in research by verification with high-sensitivity imaging. Copyright (C) 2010 S. Karger AG, Basel