Early functional recovery and the fate of the diffusion/perfusion mismatch in patients with proximal middle cerebral artery occlusion

Cerebrovasc Dis. 2004;17(1):13-20. doi: 10.1159/000073893. Epub 2003 Oct 3.


Background: The relationship between early neurological recovery, time to recanalization and the salvage of hypoperfused, but not diffusion-restricted tissue was investigated.

Methods: In 17 patients with acute middle cerebral artery occlusion, a multiparametric stroke MRI protocol was performed < 6 h after symptom onset, as well as at day 2 and 7. Recanalization was monitored with transcranial Doppler or with conventional angiography (during local thrombolysis). Functional improvement was defined as a change of > or = 4 points on the National Institutes of Health Stroke Scale score.

Results: In patients with functional improvement, 78% (median, range 66-95%) of the acute mean transit time (MTT) lesion escaped infarction compared with 28% (median, range -13 to 78%) in patients without neurological improvement (p < 0.01). Similarly, the percentage of tissue with a time-to-peak (TTP) delay of > or = 2 s not progressing to infarction was 80 and 4% in the groups with and without improvement, respectively (p < 0.01). Neurological improvement was more frequent in patients with early (< or = 3 h after presentation) recanalization, due to the salvage of larger areas of initially hypoperfused tissue.

Conclusions: The salvage of hypoperfused tissue is a major factor influencing early neurological improvement.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cerebrovascular Circulation / physiology*
  • Diffusion Magnetic Resonance Imaging*
  • Female
  • Follow-Up Studies
  • Humans
  • Infarction, Middle Cerebral Artery / diagnosis*
  • Infarction, Middle Cerebral Artery / physiopathology*
  • Infarction, Middle Cerebral Artery / therapy
  • Magnetic Resonance Angiography*
  • Male
  • Middle Aged
  • Prognosis
  • Recovery of Function / physiology
  • Thrombolytic Therapy
  • Time Factors