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Abstract

Background

Diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) mismatch was suggested to identify stroke patients with unknown time of symptom onset likely to be within the time window for thrombolysis.

Aims

We aimed to study clinical characteristics associated with DWI-FLAIR mismatch in patients with unknown onset stroke.

Methods

We analyzed baseline MRI and clinical data from patients with acute ischemic stroke proven by DWI from WAKE-UP, an investigator-initiated, randomized, placebo-controlled trial of MRI-based thrombolysis in stroke patients with unknown time of symptom onset. Clinical characteristics were compared between patients with and without DWI-FLAIR mismatch.

Results

Of 699 patients included, 418 (59.8%) presented with DWI-FLAIR mismatch. A shorter delay between last seen well and symptom recognition (p = 0.0063), a shorter delay between symptom recognition and arrival at hospital (p = 0.0025), and history of atrial fibrillation (p = 0.19) were predictors of DWI-FLAIR mismatch in multivariate analysis. All other characteristics were comparable between groups.

Conclusions

There are only minor differences in measured clinical characteristics between unknown symptom onset stroke patients with and without DWI-FLAIR mismatch. DWI-FLAIR mismatch as an indicator of stroke onset within 4.5 h shows no relevant association with commonly collected clinical characteristics of stroke patients.

Clinical Trial Registration

URL: http://www.clinicaltrials.gov. Unique identifier: NCT01525290; URL: https://www.clinicaltrialsregister.eu. Unique identifier: 2011-005906-32.

Keywords

Acute ischemic stroke magnetic resonance imaging clinical trial diffusion-weighted imaging fluid-attenuated inversion recovery imaging diffusion-weighted imaging and fluid-attenuated inversion recovery mismatch WAKE-UP

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Clinical characteristics of unknown symptom onset stroke patients with and without diffusion-weighted imaging and fluid-attenuated inversion recovery mismatch

Abstract

Background

Aims

Methods

Results

Conclusions

Clinical Trial Registration

Keywords

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References