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Background and Purpose-MRI is useful for detecting early ischemic lesions before administration of tissue plasminogen activator in patients with hyperacute ischemic stroke. However, it is unclear whether early ischemic change seen on diffusion-weighted imaging (DWI) can be used to predict patient outcomes. Methods-Consecutive patients with anterior circulation ischemic stroke treated with tissue plasminogen activator within 3 hours of stroke onset were prospectively studied. The National Institutes of Health Stroke Scale score was obtained before and 7 days after tissue plasminogen activator administration. MRI, including DWI, was done before tissue plasminogen activator thrombolysis. The relationship between the DWI Alberta Stroke Programme Early CT Score (ASPECTS) and patients' outcomes was assessed. Results-The subjects consisted of 49 consecutive patients with stroke (27 males; mean age, 72.9Ϯ10.3 years). The median (range) of the baseline DWI ASPECTS value was 9 (3-10). Dramatic improvement was seen in one of 8 patients with an ASPECTS Յ5 compared with 21 of 41 patients with a DWI ASPECTS Ͼ5 (Pϭ0.0592). On the other hand, worsening was noted more frequently in patients with a DWI ASPECTS Յ5 (3 of 8 patients) than in patients with an ASPECTS Ͼ5 (4 of 41 patients; Pϭ0.0753). Bad outcome was seen more frequently in patients with a DWI ASPECTS Յ5 (6 of 8 patients) than in patients with a DWI ASPECTS Ͼ5 (2 of 41 patients; PϽ0.0001). Multivariate logistic regression analysis demonstrated that a DWI ASPECTS Յ5 was the only independent predictor of a bad outcome (OR, 33.4; 95% CI, 2.7 to 410.8; Pϭ0.0062). Conclusion-DWI ASPECTS appears to be a reliable tool for predicting bad outcome. Patients with a DWI ASPECTS Ͼ5 should be considered eligible for tissue plasminogen activator therapy.

Glucose level appears to influence infarct volume growth and neurological deterioration, particularly in non-diabetic patients with ischaemic stroke.

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The aim of the present study was to investigate the frequency of having occult malignancy in patients with acute ischemic stroke and their clinical characteristics. We retrospectively enrolled 1,714 consecutive ischemic stroke patients within 7 days of onset. The patients were divided into two groups: the Non-M group had no malignancy, and the M group had malignancy. We compared the clinical characteristics of the two groups. Of 1,714 ischemic stroke patients, 51 patients (3.0%; M group) were newly diagnosed as having malignancy. The M group was significantly older than the Non-M group (p = 0.009). Hemoglobin (Hb) was less and D-dimer was higher in the M group than in the Non-M group (p < 0.001). The patients with both D-dimer ≧1.3 ng/dl and Hb <12.8 g/dl more frequently had occult malignancy than patients without (p = 0.0088).