Renard et al developed an MRI-based score to evaluate a patient with acute basilar artery thrombosis. This can help to identify a patient who may benefit from recombinant tissue plasminogen activator therapy. The authors are from Hopital Gui de Chauliac and Hopital Antoine Gayraud in France.
Study: MRI with diffuse-weighted images (DWI)
Poor outcome: modified Rangkin score of 3 to 6 (6= death) at 3 months
Parameters:
(1) lesions in left medulla
(2) lesions in right medulla
(3) lesions in left pons
(4) lesions in right pons
(5) lesions in left mesencephalon
(6) lesions in right mesencephalon
(7) lesions in left cerebellum
(8) lesions in right cerebellum
(9) lesions in left thalamus
(10) lesions in right thalamus
(11) lesions in left temporo-occipital lobe
(12) lesions in right temporo-occipital lobe
|
Parameter
|
Finding
|
Points
|
|
left medulla
|
no
|
0
|
|
|
yes
|
1
|
|
right medulla
|
no
|
0
|
|
|
yes
|
1
|
|
left pons
|
no
|
0
|
|
|
yes
|
1
|
|
right pons
|
no
|
0
|
|
|
yes
|
1
|
|
left mesencephalon
|
no
|
0
|
|
|
yes
|
1
|
|
right mesencephalon
|
no
|
0
|
|
|
yes
|
1
|
|
left cerebellum
|
no
|
0
|
|
|
yes
|
1
|
|
right cerebellum
|
no
|
0
|
|
|
yes
|
1
|
|
left thalamus
|
no
|
0
|
|
|
yes
|
0.5
|
|
right thalamus
|
no
|
0
|
|
|
yes
|
0.5
|
|
left temporo-occipital lobe
|
no
|
0
|
|
|
yes
|
0.5
|
|
right temporo-occipital lobe
|
no
|
0
|
|
|
yes
|
0.5
|
total score =
= SUM(points for all 12 parameters)
Interpretation:
• minimum score: 0
• maximums score: 10
• The presence of a high number of acute ischemic lesions is associated with a poor outcome.
• A score > 3 was associated with a poor outcome.
• Additional predictors of a poor outcome: age > 60 years, coma on admission, NIHSS >= 22
