Author Response: Early Neurologic Deterioration in Lacunar Stroke: Clinical and Imaging Predictors and Association With Long-term Outcome

Vynckier, Jan; Seiffge, David J; Fischer, Urs

doi:10.1212/wnl.0000000000013257

Cited by 34 publications

(65 citation statements)

References 2 publications

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“…In addition to that, Jiang ( Jiang et al, 2019 ) et al pointed out that the clinical progression of subcortical small infarction was correlated with the history of hypertension, and whether there was a significant correlation needed to be further studied with a large sample. Meanwhile, in our study, aspirin and clopidogrel were the main drugs that patients received during admission, we found no statistical difference between the two groups in combination or single administration of the two drugs, however, Vynckier ( Vynckier et al, 2021 ) et al suggested that dual antiplatelet therapy was associated with reduced risk of clinical progression, the difference between the two results may be attributed to our small sample size.…”

Section: Discussioncontrasting

confidence: 65%

The value of diffusion weighted imaging in predicting the clinical progression of perforator artery cerebral infarction

Yang

Liu

et al. 2022

NeuroImage: Clinical

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Section: Discussioncontrasting

confidence: 65%

The value of diffusion weighted imaging in predicting the clinical progression of perforator artery cerebral infarction

Yang

Liu

et al. 2022

NeuroImage: Clinical

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“…The relationship between initial NIHSS and END in pontine infarction is unclear. One study showed that higher initial stroke severity was associated with END [17], whereas another study reported that lower initial NIHSS was independently associated with END [6]. In the present study, we found that lower initial NIHSS was related to END.…”

Section: Discussionsupporting

confidence: 51%

“…Although the initial stroke severity, diabetes mellitus, larger infarct volume, initial high blood pressure, and various inflammatory parameters have been proposed, the predictors of END remain uncertain [4]. Recent studies using perfusion imaging have shown that the presence of hypoperfusion in the ischemic area is associated with END [5], which may be related to the subacute increase in the lesion volume [6]. Other studies have shown that arterial tortuosity can induce distortion and stretching of the branching vessels, thereby resulting in hemodynamic instability and hypo-perfused state [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Basilar Artery Tortuosity May Be Associated with Early Neurological Deterioration in Patients with Pontine Infarction

Ha¹,

Kim²,

Ryu³

et al. 2022

Cerebrovasc Dis

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Background: Early neurological deterioration (END) occurs in patients with pontine infarction that is adversely associated with a long-term functional outcome. As basilar artery (BA) tortuosity may alter hemodynamics, we investigated whether factors including BA tortuosity are associated with END and poor outcome at 3 months. Methods: We reviewed patients with acute (<7 days from stroke onset) unilateral pontine infarction mainly involving the pontine base and/or tegmental regions from January 2017 through April 2021. END was defined as increase of ≥2 in total National Institutes of Health Stroke Scale (NIHSS) score or ≥1 in motor NIHSS score within first 72 h. A poor clinical outcome was defined as modified Rankin Scale (mRS) 3–6 at 3 months. The BA tortuosity index (TI) was measured: ([actual/straight length −1] x 100). To assess interobserver agreement, TI measurements were obtained by 2 independent raters. Results: The study included 245 patients; END occurred in 72 (29.3%) and 35 (14.2%) showed poor outcome at 3 months. Old age (odds ratio [OR] = 1.03, 95% confidence interval [CI] 1.004–1.062; p = 0.027), previous stroke history (OR = 2.36, 95% CI: 1.176–4.717; p = 0.016), lower initial NIHSS (OR = 0.72, 95% CI: 0.628–0.827; p < 0.001), and high BA TI (OR = 1.17, 95% CI: 1.062–1.295; p = 0.002) were associated with END. On the other hand, old age (OR = 1.04, 95% CI: 1.002–1.073; p = 0.037) and END (OR = 3.03, 95% CI: 1.429–6.403; p = 0.004) were associated with poor outcome at 3 months. Conclusions: High BA tortuosity may be a factor associated with END in patients with pontine infarction. As END was related to unfavorable clinical outcome, this risk may have to be carefully considered in patients with high BA tortuosity.

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“…We hope that more high-quality studies will be designed to study the effects of the infarct site and infarct size on END in the future. Previous BAD-related studies have shown that early intravenous thrombolysis does not prevent the occurrence of END [13,26,27]. Strategies to prevent the occurrence of END are currently an important topic.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for early neurological deterioration in acute isolated pontine infarction without any causative artery stenosis

Liu

Peng²,

Wang

et al. 2022

BMC Neurol

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Background This study aimed to investigate the risk predictors for early neurological deterioration (END) in isolated acute pontine infarction without any causative artery stenosis. Methods In this retrospective study, patients with isolated acute pontine infarction within 72 h of symptom onset were enrolled between October 2017 and December 2021. END was defined as an increase in the National Institutes of Health Stroke Scale (NIHSS) score ≥ 2 points within the first week postadmission. Patients were divided into the END and the non-END groups. Multiple logistic regression analysis was used to evaluate independent predictors of END in patients with isolated acute pontine infarction. Results A total of 153 patients were included in the final study (62 females; mean age, 67.27 ± 11.35 years), of whom 28.7% (47 of 153) experienced END. Multiple logistic regression analyses showed that infarct volume (adjusted odds ratio [aOR], 1.003; 95% CI, 1.001–1.005; P = 0.002) and basilar artery branch disease (aOR, 3.388; 95% CI, 1.102–10.417; P = 0.033) were associated with END. The combined ROC analysis of the infarct volume and basilar artery branch disease for predicting END showed that the sensitivity and specificity were 80.9% and 72.6%, respectively. Conclusion Basilar artery branch disease and infarct volume were associated with END in acute isolated pontine infarction and may be useful prognostic factors for neurological progression.

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Author Response: Early Neurologic Deterioration in Lacunar Stroke: Clinical and Imaging Predictors and Association With Long-term Outcome

Abstract: This collaboration between the American Academy of Neurology (AAN) and the Child Neurology Society (CNS) represents a collection of reprinted cases from the past 15 years from the Neurology Resident & Fellow Section.

Cited by 34 publications

References 2 publications

The value of diffusion weighted imaging in predicting the clinical progression of perforator artery cerebral infarction

The value of diffusion weighted imaging in predicting the clinical progression of perforator artery cerebral infarction

Basilar Artery Tortuosity May Be Associated with Early Neurological Deterioration in Patients with Pontine Infarction

Risk factors for early neurological deterioration in acute isolated pontine infarction without any causative artery stenosis

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