Background and Aims

Stroke is the second-leading global cause of death behind heart disease and is a major cause of permanent disability. Acute stroke management needs extended time window in Indian setting. Hence we looked at DWI/FLAIR mismatch (DFM) beyond the 4.5 hour window.

To identify DFM in acute ischemic stroke upto 9 hours after onset.

Methods

This is a hospital based prospective observational study over a period of 12 months. The study subjects were enrolled after informed consent. Consecutive patients of acute ischemic stroke patients within 9 hours, confirmed by MRI, attending the neurology department of Ramesh hospital, Guntur were studied.

Results

A total of 108 participants were included in the study. The mean age was 60.29 ± 14.27 years. Males were predominant in the study population (61.11%). Majority of the participants had hypertension(75%), diabetes mellitus(51%) and hypercholesterolemia(18%). 82.41% of participants had DFM. Majority of the participants had middle cerebral artery occlusion(71.30%). 79.63% of eligible participants were thrombolysed. The mean NIHSS score was 8.78 ± 5.34. In people with symptom to ER time <4.5 hours 95.29% of participants had DFM, and 4.71% of participants had no mismatch. Among people with symptom to ER time 4.51 to 9 hours, 38.46% of participants had DFM, and 61.54% of participants had no mismatch. Whereas, in > 9 hours, 30% of participants had DFM, and 70% of participants had no mismatch.

Conclusions

A significant proportion of patients had DWI and FLAIR mismatch outside the 4.5 hour window. Extending thrombolysis beyond 4.5 hours may be feasible as per DFM criterion.