Progressive deficit in isolated pontine infarction: the association with etiological subtype, lesion topography and outcome

Abstract

It is important to predict progressive deficit (PD) in isolated pontine infarction, a relatively common problem of clinical stroke practice. Traditionally, lacunar infarctions are known with their progressive course. However, few studies have analyzed the branch atheromatous disease subtype as a subtype of lacunar infarction, separately. There are also conflicting results regarding the relationship with the topography of lesion and PD. In this study, we classified etiological subtypes and lesion topography in isolated pontine infarction and aimed to investigate the association of etiological subtypes, lesion topography and clinical outcome with PD. We analyzed demographics, laboratory parameters, and risk factors of 120 patients having isolated pontine infarction and admitted within 24 h retrospectively. PD was defined as an increase in the National Institutes of Health Stroke scale ≥2 units in 5 days after onset. Patients were classified as following: large artery disease (LAA), basilar artery branch disease (BABD) and small vessel disease (SVD). Upper, middle and lower pontine infarcts were identified longitudinally. Functional outcome at 3 months was determined according to modified Rankin scores. Of 120 patients, 41.7% of the patients were classified as BABD, 30.8% as SVD and 27.5% as LAA. 23 patients (19.2%) exhibited PD. PD was significantly more frequent in patient with BABD (p 0.006). PD was numerically higher in patients with lower pontine infarction. PD was associated with BABD and poor functional outcome. It is important to discriminate the BABD neuroradiologically from other stroke subtypes to predict PD which is associated with poor functional outcome in patients with isolated pontine infarctions.

Apparent diffusion coefficient signature of ischemic tissue predicts neurological progression in isolated pontine infarcts

“…3,4 In addition to this mechanistic diversity, one additional challenge in the care of patients with acute pontine infarcts is the tendency of clinical deficits to fluctuate or progress in the first few days after symptom onset, with reports highlighting early motor deterioration ranging from 19% to 32% of cases. [5][6][7][8][9][10][11] The determination of high-risk patients for progression is important as these patients are well-known to have worse neurological outcomes in the long term. 8,12 Female sex, history of hypertension and diabetes mellitus, and higher admission National Institutes of Health Stroke Scale (NIHSS) scores have been highlighted as clinical factors that might be predictive of neurological worsening.…”

“…7,8,10,11,13 Several other studies underlined the importance of radiological features in predicting progression and suggested caudal location, longer vertical extent, and a pattern suggestive of branch artery occlusion as lesion characteristics associated with a higher rate of early motor deterioration. 6,8,10,13 The magnitude of the decrease in apparent diffusion coefficient (ADC) is closely related to fate of clinical and tissue outcome in territorial strokes. [14][15][16] In this study, our aim was to assess whether a similar ADC based approach could be used as an additional radiomic feature to forecast clinical deterioration in acute pontine infarctions.…”

Monocyte to High-Density Lipoprotein Ratio Is Associated With Early Neurological Deterioration in Acute Isolated Pontine Infarction

“…Meanwhile, early neurological deterioration is one of the most concerning clinical problems in patients with branch atherosclerotic diseases. Progressive deficit has been associated with basilar artery branch disease and poor functional outcomes ( 41 ). Therefore, the progression of vascular stenosis or thrombosis caused by intracranial atherosclerosis is related to END.…”

“…Earlier studies have identified the presence of comorbidities (such as diabetes and hypertension), female sex, infarct size, and neurological severity at onset to be associated with progressive deficit in patients with isolated pontine infarctions. However, some studies have reported inconsistent findings ( 41 ). In addition, the infarct area extending to the basal surface was 2.5 times greater than deep infarctions without extension to the basal surface ( 41 ).…”

“…However, some studies have reported inconsistent findings ( 41 ). In addition, the infarct area extending to the basal surface was 2.5 times greater than deep infarctions without extension to the basal surface ( 41 ). Compared to LPI, PPI was related to END in the univariate analysis in our study.…”