The DASH score: A simple score to assess risk for development of malignant middle cerebral artery infarction

Abstract Background and purpose The aim of the present study was to devise a simple grading scale for assessing the risk of development of malignant MCA infarction (MMI). Methods Using MRI, patients with MCA infarction and proximal vessel occlusion (ICA or M1) within 24 h of onset were retrospectively studied. MMI was defined as clinical deterioration, midline shift ≥ 5 mm, or brain herniation within 48 h of admission. We evaluated clinical factors independently associated with MMI and created a simple score according to the multivariate logistic regression analysis. Results Subjects comprised 119 patients, 57 of which (47.9%) developed MMI. Multivariate logistic regression analysis revealed the following independent factors associated with MMI: DWI ASPECTS ≤ 3 [odds ratio (OR), 4.16; 95% CI, 1.36–12.66, P = 0.012], ACA territory involvement [OR, 6.90; 95% confidence interval [CI], 2.06–23.10, P = 0.002], M1 susceptibility vessel sign (SVS) on T2*-gradient echo [OR, 4.55; 95% CI, 1.38–14.98, P = 0.013], and hyperglycemia (glucose value ≥ 145 mg/dl) [OR, 5.31; 95% CI, 1.80–15.68, P = 0.002]. These four variables were selected for use in the DASH score, with DWI ASPECTS ≤ 3 as 1 point, ACA territory involvement as 1 point, M1 SVS as 1 point, and hyperglycemia as 1 point. The likelihood of developing MMI for each score was as follows: score 0, 9.1%; score 1, 20.5%; score 2, 63.0%; score 3–4, 96.8%. The C statistic for the score was 0.88 (95% CI, 0.82–0.94, P < 0.001). Conclusion Our DASH score reliably assessed a risk for development of MMI in large MCA infarctions.