Lesion Topography and Its Correlation With Etiology in Medullary Infarction: Analysis From a Multi-Center Stroke Study in China

Abstract

Objectives: The lesion topography of medullary infarction (MI) is heterogeneous and its correlation with stroke etiology remains elusive. We aim to clarify the lesion pattern of MI and to assess its correlation with stroke etiology.Material and Methods: Of 1129 subjects with available DWI in SMART study (a multi-center trial concerning secondary stroke prevention in China) between April 2008 and December 2010, 43 patients with DWI confirmed MI (3.8%) were retrospectively evaluated. Lesions were categorized as lateral and medial medullary infarction (LMI and MMI, 33 and 10 subjects respectively) at 3 levels rostro-caudally and correlated with the stroke etiology. Clinical profiles and long-term prognosis were analyzed.Results: Large artery atherosclerosis, small vessel occlusion, cardiogenic embolism and artery dissection accounted for 29, 11, 1, and 2 infarcts, respectively. Large artery disease was the most common cause in LMI (24 of 33, 72.7%) whereas small vessel occlusion was not uncommon in MMI (5 of 10, 50.0%). Though the difference of infarct pattern between large artery atherosclerosis and small vessel occlusion was insignificant, two distinct lesion patterns were considered to be relevant: (1) Rostral MMI with continuous medial pontine infarctions were more likely attributed to small vessel occlusion than large artery atherosclerosis. Kameda et al. (2) MMI with ventral to dorsal extension were more often caused by large artery disease than small vessel occlusion. Median NIHSS at admission was 4. During a median follow-up of 17 months, 2 patients died and 2 experienced recurrent ischemic events, 39 of 41 subjects (95.1%) were functional independent (mRS 0–2).Conclusions: This multi-center study demonstrates that MI has distinct lesion pattern depending on various stroke etiologies and mechanisms. Future investigations with larger sample size should establish the lesion pattern of MI and validate its correlation with the stroke etiology and mechanisms, which might improve stroke management.

A comparative analysis of 375 patients with lateral and medial medullary infarction

“…There is a predisposition that LMI was more frequently located in the middle medulla and MMI was located more in the upper medulla in our study, which was consistent with previous results (Hong et al, 2018;Kameda et al, 2004). The different infarction subtype of LMI could be explained by the anatomical course of the VA: a pair of VAs locates adjacent to the lateral surface of the lower medulla and ascends anteroinferiorly to fuse to the basilar artery (Kim, 2003).…”

“…However, several researches revealed different results on the etiology in MMI. Hong et al (2018), Kim et al (2012), and Shono et al (2010) reported that SVD was the most common mechanism in MMI. Moreover, VA dissection played an equally important role in LMI and MMI in a recent study (Kameda et al, 2004).…”

A Nomogram to Predict Lifestyle Factors for Recurrence of Large-Vessel Ischemic Stroke

“…Studies have shown that between 39.4 and 68.0% ischemic stroke in Chinese population are due to large artery atherosclerosis. 34–36 We observed that large artery atherosclerosis comprised 61% (258/421) of all ischemic stroke in the patient cohort in the present study. Thus, it is not surprising that adequate HDL levels are associated with decreased risk for RS in patients with ALVIS.…”

Risk Factors for Long-Term Death After Medullary Infarction: A Multicenter Follow-Up Study

“…There is a paucity of studies on the long-term prognosis of patients with MI; in particular, there is no credible data on the prevalence of poor outcomes. In a recent study of 43 MI patients involving a median follow-up of 17 months, two patients died and two patients experienced recurrent ischemic events ( 19 ). A more recent investigation of 81 MI patients showed generally favorable outcomes ( 9 ).…”