Open AccessAssociation of laterality and size of perfusion lesions on neurological deficit in acute supratentorial stroke
Author(s) -
Lee Meng,
Saver Jeffrey L.,
Alger Jeffry R.,
Hao Qing,
Salamon Noriko,
Starkman Sidney,
Ali Latisha K.,
Ovbiagele Bruce,
Kim Doojin,
Villablanca J Pablo,
Froehler Michael T.,
Tenser Matthew S.,
Liebeskind David S.
Publication year - 2012
Publication title -
international journal of stroke
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.375
H-Index - 74
eISSN - 1747-4949
pISSN - 1747-4930
DOI - 10.1111/j.1747-4949.2011.00726.x
Subject(s) - medicine , stroke (engine) , laterality , perfusion scanning , lateralization of brain function , physical medicine and rehabilitation , physical therapy , perfusion , weakness , cardiology , audiology , surgery , mechanical engineering , engineering
Background The influence of lesion size and laterality on each component of the N ational I nstitutes of H ealth S troke S cale has not been delineated. The objective of this study was to use perfusion‐weighted imaging to characterize the association of ischaemic volume and laterality on each component item and the total score of the < N ational I nstitutes of H ealth S troke S cale. Methods We analysed consecutive right‐handed patients with first‐ever supratentorial acute ischaemic strokes who underwent acute perfusion‐weighted imaging at a single centre. Perfusion deficits were defined as mean transit time > 10 s. Ordinal regression was used to clarify the relationship between ischaemic volume, laterality, and < N ational I nstitutes of H ealth S troke S cale scores. Results Among 111 patients, 58 were left‐hemisphere stroke, and 53 right‐hemisphere stroke. Median ischaemic volume was 53 ml in left‐hand stroke and 65 ml in right‐hand stroke and median total N ational I nstitutes of H ealth S troke S cale was 10 in left‐hand stroke and eight in right‐hand stroke. For individual N ational I nstitutes of H ealth S troke S cale items, ischaemic volume correlated most closely with commands and visual field and most weakly with ataxia and neglect. Left‐hand stroke predicted higher scores of total N ational I nstitutes of H ealth S troke S cale and N ational I nstitutes of H ealth S troke S cale items of questions, commands, right limb weakness, and language. Right‐hand stroke predicted higher scores of left limb weakness and extinction. Conclusions Larger perfusion defects contribute to higher scores on the total and most individual items of the N ational I nstitutes of H ealth S troke S cale. However, lesion laterality contributes substantially to half the item scores, with greater association of left than right‐brain side. These findings indicate that imaging‐deficit correlations will be improved by designating lesions into an atlas, taking into account side in addition to size.