Clinical and Prognostic Correlates of Stroke Subtype Misdiagnosis Within 12 Hours From Onset

Toni, Danilo; Fiorelli, Marco; Michele, Manuela De; Bastianello, Stefano; Sacchetti, Maria Luisa; Montinaro, E.; Zanette, E.; Argentino, C.

doi:10.1161/01.str.26.10.1837

Cited by 24 publications

(22 citation statements)

References 20 publications

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“…Our results support the conclusions of Norrving and Cronqvist [6] and Toni et al [26] that the ischemic stroke mechanism is variably predicted by initial examination alone, particularly in the absence of cortical deficits. Thus, significant risk factors for cortical ischemic stroke in this study, particularly atrial fibrillation by EKG, nonalert mental status and recent hospitalization, may be relevant.…”

Section: Discussionsupporting

confidence: 91%

“…The focus of these reviews has often been on overdiagnosis of lacunar stroke due to a variable predictive value of lacunar syndromes. Toni et al [26] note that atrial fibrillation in particular has a low odds ratio (0.55) for lacunar stroke but is almost equally represented in lacunar and nonlacunar syndromes, while Chimowitz et al [27] found that only 38% of lacunar syndromes are due to lacunar stroke. In a large prospective study, Gan et al [28] found lacunar syndromes to have an overall PPV of 87% for detection of radiologic lacunae.…”

Section: Discussionmentioning

confidence: 99%

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Differentiation of Acute Cortical and Subcortical Ischemic Stroke by Risk Factors and Clinical Examination Findings

Dulli¹,

D’Alessio

Palta

et al. 1998

Neuroepidemiology

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Background: Differentiation between acute cortical and subcortical ischemic stroke may be problematic when cortical stroke presents without obvious cortical deficits such as aphasia, neglect or hemianopia. This study explores stroke risk factors and clinical variables that may assist in this differentiation. Methods: Records of consecutive patients with acute ischemic stroke, examined within 72 h of symptom onset, were reviewed. Stroke type was verified by clinical course and follow-up imaging. Stroke risk factors and acute examination findings were compared by odds ratios and positive predictive values for cortical and subcortical stroke. Results: For 355 patients studied, 237 had cortical stroke and 118 had subcortical stroke. Odds ratios for cortical stroke were highest for atrial fibrillation by EKG (OR = 4.77, CI = 2.08–10.94), recent hospitalization (OR = 4.51, CI = 2.39–8.53) and nonalert mental status (OR = 4.50, CI = 2.29–8.87). Possible cardioembolic condition, ischemic heart disease and peripheral vascular disease were also significant, but hypertension, age and diabetes mellitus were not significantly different for the stroke subtypes. Cortical deficits were absent in 19.4% of cortical stroke patients on initial examination. Predictive models were generated based on the presence or absence of cortical deficits and the interaction of significant risk factors with degree of motor deficit. Conclusions: There are clinical features that, in addition to initial examination, may help differentiate cortical from subcortical ischemic stroke. These features may be relevant to both diagnostic and therapeutic approaches to acute stroke.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Differentiation of Acute Cortical and Subcortical Ischemic Stroke by Risk Factors and Clinical Examination Findings

Dulli¹,

D’Alessio

Palta

et al. 1998

Neuroepidemiology

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show abstract

“…Ability to recall symptoms and signs may deteriorate with increasing time to assessment, particularly with speech disorders. Others have reported problems with very early or very late diagnosis of lacunar stroke [24]. Our use of maximum deficit in assigning the OCSP subtype may have overcome any effect of time on stroke diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Associations of Clinical Stroke Misclassification (‘Clinical-Imaging Dissociation’) in Acute Ischemic Stroke

et al. 2010

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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.

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“…The four classical lacunar syndromes and the sensorimotor syndrome [30-35, 67] do not predict a lacunar infarct when used in the first hours of stroke [89,90]. Later they have a reasonable predictive power if the classic definitions are retained [14,36,42,59].…”

Section: ■ Subcortical Hemispherical Infarctsmentioning

confidence: 99%

Patterns of ischaemic cerebral diseases

Ferro

2004

Journal of Neurology

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Clinical and Prognostic Correlates of Stroke Subtype Misdiagnosis Within 12 Hours From Onset

Cited by 24 publications

References 20 publications

Differentiation of Acute Cortical and Subcortical Ischemic Stroke by Risk Factors and Clinical Examination Findings

Differentiation of Acute Cortical and Subcortical Ischemic Stroke by Risk Factors and Clinical Examination Findings

Associations of Clinical Stroke Misclassification (‘Clinical-Imaging Dissociation’) in Acute Ischemic Stroke

Patterns of ischaemic cerebral diseases

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