Ischemic lesion volume correlates with long-term functional outcome and quality of life of middle cerebral artery stroke survivors.

PURPOSE Previous studies investigating relationships between stroke lesion volume and outcome were restricted to short follow-up periods (3-6 months) and outcome measures of stroke severity and activities only, whereas functional improvement has been found to extend far beyond six months. Therefore, this study investigated relationships between infarct volume and a broad range of outcomes of stroke survivors at a long follow-up period. METHODS Correlations between lesion volumes (determined by conventional MRI scans in the second week post-stroke) and outcomes after one year of 75 first-ever ischemic stroke survivors were investigated. RESULTS Moderate Spearman Rank correlation coefficients were found between lesion volume and motor impairment (Motricity Index (MI): -0.43, p < 0.01; Fugl Meyer Motor Assessment Scale (FM): -0.43; p < 0.01). Correlation coefficients with activities of daily living were moderate but low associated with Barthel Index (r(s) = 0.30; p < 0.01), modified Rankin Scale (r(s) = 0.39; p < 0.01) and Frenchay Activities Index (r(s) = -0.35; p < 0.01). Lesion volume had a significant but low association (r(s) = 0.27; p = 0.02) with patient's health status measured with Sickness Impact Profile 68 (SIP68)) and a moderate correlation with well-being assessed with Life Satisfaction Questionnaire (LSQ; r(s) = -0.45; p < 0.01). Found correlation coefficients were slightly stronger after correction for mixed (cortical/subcortical) and purely subcortical lesion location. CONCLUSIONS It can be concluded that infarct volume moderately correlates with long-term motor impairment, functional outcome and quality of life of patients surviving stroke.

[1]  Mahoney Fi,et al.  FUNCTIONAL EVALUATION: THE BARTHEL INDEX. , 1965 .

[2]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[3]  M. Bergner,et al.  The Sickness Impact Profile: Development and Final Revision of a Health Status Measure , 1981, Medical care.

[4]  D. Wade,et al.  Social activities after stroke: measurement and natural history using the Frenchay Activities Index. , 1985, International rehabilitation medicine.

[5]  H. Schouten,et al.  Interobserver agreement for the assessment of handicap in stroke patients. , 1988, Stroke.

[6]  C. Warlow,et al.  Evolution and testing of the lacunar hypothesis. , 1988, Stroke.

[7]  T Brott,et al.  Measurements of acute cerebral infarction: lesion size by computed tomography. , 1989, Stroke.

[8]  C. Martin,et al.  Comparison of four severity scores in patients with head trauma. , 1989, The Journal of trauma.

[9]  J. Marler,et al.  Measurements of acute cerebral infarction: a clinical examination scale. , 1989, Stroke.

[10]  D. Wade,et al.  Mobility after stroke: reliability of measures of impairment and disability. , 1990, International disability studies.

[11]  T. S. Olsen Outcome following occlusion of the middle cerebral artery , 1991, Acta neurologica Scandinavica.

[12]  C. Fisher Lacunar Infarcts – A Review , 1991 .

[13]  S. Bandinelli,et al.  Recovery of Functional Status After Stroke: A Postrehabilitation Follow‐up Study , 1993, Stroke.

[14]  P. Stratford,et al.  Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke. , 1993, Physical therapy.

[15]  P D Lyden,et al.  A Rapid, Reliable, and Valid Method for Measuring Infarct and Brain Compartment Volumes From Computed Tomographic Scans , 1994, Stroke.

[16]  R. Schall,et al.  Determining Functional/Health Status and Its Relation to Disability in Stroke Survivors , 1994, Stroke.

[17]  L. D. de Witte,et al.  The sickness impact profile: SIP68, a short generic version. First evaluation of the reliability and reproducibility. , 1994, Journal of clinical epidemiology.

[18]  J. Hopper,et al.  Prediction of functional outcome and tissue loss in acute cortical infarction. , 1995, Archives of neurology.

[19]  G. Comi,et al.  Resolution‐dependent estimates of lesion volumes in magnetic resonance imaging studies of the brain in multiple sclerosis , 1995, Annals of neurology.

[20]  D. Saunders,et al.  Measurement of infarct size using MRI predicts prognosis in middle cerebral artery infarction. , 1995, Stroke.

[21]  M. Limburg,et al.  Assessing quality of life after stroke. The value and limitations of proxy ratings. , 1997, Stroke.

[22]  Gottfried Schlaug,et al.  Ischemic lesion volumes in acute stroke by diffusion‐weighted magnetic resonance imaging correlate with clinical outcome , 1997, Annals of neurology.

[23]  W. Mali,et al.  Diffusion-weighted magnetic resonance imaging in acute stroke. , 1998, Stroke.

[24]  A. J. van Dijk,et al.  Life satisfaction of persons with spinal cord injury compared to a population group. , 1998, Scandinavian journal of rehabilitation medicine.

[25]  C. Beaulieu,et al.  Longitudinal magnetic resonance imaging study of perfusion and diffusion in stroke: Evolution of lesion volume and correlation with clinical outcome , 1999, Annals of neurology.

[26]  A R Localio,et al.  Reliability and validity of estimating the NIH stroke scale score from medical records. , 1999, Stroke.

[27]  W. Koroshetz,et al.  Infarct volume as a surrogate or auxiliary outcome measure in ischemic stroke clinical trials. The RANTTAS Investigators. , 1999, Stroke.

[28]  M E Moseley,et al.  Is Early Ischemic Lesion Volume on Diffusion-Weighted Imaging an Independent Predictor of Stroke Outcome?: A Multivariable Analysis , 2000, Stroke.

[29]  A. Meyers,et al.  Health-related quality of life outcomes measures. , 2000, Archives of physical medicine and rehabilitation.

[30]  P M Matthews,et al.  Relating MRI changes to motor deficit after ischemic stroke by segmentation of functional motor pathways. , 2000, Stroke.

[31]  R. Macwalter,et al.  Relationship of Volume of Lesion to Length of Hospital Stay and Outcome at One Year in Stroke Patients , 2001, Scottish medical journal.

[32]  A. Algra,et al.  Reproducibility of Measurements of Cerebral Infarct Volume on CT Scans , 2001, Stroke.

[33]  G. Westert,et al.  Socioeconomic variations in the course of stroke: unequal health outcomes, equal care? , 2002, Journal of epidemiology and community health.

[34]  G. Kwakkel,et al.  Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. , 2003, Stroke.

[35]  Further evidence for the agreement between patients with stroke and their proxies on the Frenchay Activities Index , 2003, Clinical rehabilitation.

[36]  G. Kwakkel,et al.  Understanding the pattern of functional recovery after stroke: facts and theories. , 2004, Restorative neurology and neuroscience.

[37]  E. Andresen,et al.  The SIP68: An abbreviated sickness impact profile for disability outcomes research , 2003, Quality of Life Research.

[38]  Gereon R Fink,et al.  Development of brain infarct volume as assessed by magnetic resonance imaging (MRI): Follow‐up of diffusion‐weighted MRI lesions , 2004, Journal of magnetic resonance imaging : JMRI.

[39]  S. Bandinelli,et al.  Recovery ofFunctional Status After Stroke , 2007 .