Abstract 72: Evolution Of Cerebral Diaschisis In Childhood Arterial Ischemic Stroke
Bibliographic record
Abstract
Objectives: Early diffusion MRI (DWI) demonstrates acute restriction in corticospinal pathways after arterial ischemic stroke (AIS) that correlate with outcome. DWI may also detect changes in other remote but connected brain structures in neonatal AIS. We have termed this diaschisis and hypothesized here that the same process can be measured in childhood AIS and evolves over time. Methods: This substudy of the Validation of the Pediatric NIH Stroke Scale study prospectively enrolled 112 children with acute AIS and both acute and early follow-up (5-14 days) DWI. Inclusion criteria here were: (1) unilateral AIS (MCA), (2) acute and subacute DWI (b=1000/1500), and (3) 12 month neurological follow-up (Pediatric Stroke Outcome Measure). A validated method using Image J software quantified DWI diaschisis in anatomically connected structures. Diaschisis measures were corrected for infarct volume, and compared to imaging timing and outcome (Chi-square/Fisher, Mann-Whitney). Results: Fifteen children were evaluated (60% male, median 9.3 years). Median times to MRI were 17 and 168 hours respectively. Diaschisis was common and evolved over time; observed in 1(7%) on the 1st MR but 5(33%) by the 2nd MR. Thalamic and callosal diaschisis were most common (4, 27%). Children with diaschisis tended to be younger (7.02±5.4vs11.82±4.3years, p=0.08). Estimates of perilesional diaschisis varied (54±18% of infarct volume). Most children with poor outcome had diaschisis (3/5) while most with good outcome did not (8/10,p=0.12). Corticospinal tract DWI changes correlated with motor outcome (p=0.005). Method reliability was excellent (ρ=0.99). Conclusions: DWI diaschisis occurs in childhood AIS. Mistaking diaschisis for new areas of infarction carries important clinical implications. Improved recognition and study are required to establish clinical relevance.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".