Significance of Clinical–Diffusion Mismatch in Hyperacute Cerebral Infarction

In recent years, patient selection for intravenous tissue plasminogen activator (t-PA) therapy based on clinical–diffusion mismatch (CDM) has been closely examined. We investigated the relationship between prognosis and CDM in patients with hyperacute cerebral infarction within 3 hours of onset and compared CDM with diffusion–perfusion mismatch (DPM). Of 122 patients with hyperacute cerebral infarction who visited the hospital within 3 hours of onset between April 2007 and November 2008, 85 patients with cerebral infarction in the anterior circulation who underwent head magnetic resonance imaging diffusion-weighted imaging (DWI)/magnetic resonance angiography (MRA) (51 men and 34 women; average age, 74 ± 10 years) were enrolled. Seventeen of these patients underwent CT perfusion imaging. CDM-positive cases were those with a National Institute of Health Stroke Scale (NIHSS) score ≥8 and a DWI-Alberta Stroke Program Early CT Score (DWI-ASPECTS) ≥8; CDM-negative cases were those with an NIHSS score ≥8 and an ASPECTS-DWI