Acute Ischemic Stroke Infarct Topology: Association with Lesion Volume and Severity of Symptoms at Admission and Discharge

Voxel-based analysis of the association of admission infarct location with infarct volume, admission and discharge NIHSS scores, and NIHSS/volume ratios. The color range shows z scores, and corresponding P value thresholds are calculated after family-wise error Bonferroni correction for multiple comparisons and applying 2000 permutations. A, Ischemic infarcts are associated with larger admission DWI-lesion volumes. Higher family-wise error scores are associated with larger lesion volumes: z score = 4.27 → P value = .05; z score = 4.96 → P value = .01. B and C, Infarct lesions in voxels with higher z scores are associated with higher admission NIHSS scores (z score = 4.35 → P value = .05; z score = 4.93 → P value = .01) and discharge NIHSS scores (z score = 4.23 → P value = .05; z score = 5.01 → P value = .01). D and E, Voxel-based analysis of NIHSS/volume ratio highlights those regions where infarction is associated with a higher ratio of admission (D) and discharge (E) NIHSS scores per infarct volume, so infarction is associated with worse clinical symptoms despite a smaller volume (for admission ratios: z score = 4.30 → P value = .05; z score = 4.98 → P value = .01; for discharge ratios: z score = 4.30 → P value = .05; z score = 5.15 → P value = .01).