• Tae-Hee Cho, Marc Hermier, Josef A Alawneh, Thomas Ritzenthaler, Virginie Desestret, Leif Østergaard, Laurent Derex, Jean-Claude Baron, and Norbert Nighoghossian.
• Stroke. 2009 Oct 1;40(10):3400-2.

Background And PurposeThe perfusion-weighted imaging (PWI)/diffusion-weighted imaging (DWI) mismatch may identify patients who benefit from thrombolysis. However, some patients exhibit a "total mismatch," ie, negative DWI but extensive PWI defect. We aimed to assess clinical and MRI data of these patients.MethodsFrom June 2007 to December 2008, patients with anterior circulation ischemic stroke were evaluated for a "total mismatch" profile. MRI was performed at admission and at day 1. The score was assessed at baseline and the modified Rankin scale score was assessed at day 30.ResultsAmong 52 patients, 3 showed a total mismatch with arterial occlusion confirmed on magnetic resonance angiography. All had fluctuating symptoms (National Institutes of Health Stroke Scale scores, 0 to 10) and received intravenous tissue plasminogen activator. Day 1 DWI disclosed minimal changes in all patients. Outcome was favorable in all patients (day 30 modified Rankin scale, 0-1).ConclusionPWI may be helpful for treatment decisions in patients without DWI damage and fluctuating clinical course.

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