The Length of an Infarcted Lesion Along the Perforating Artery Predicts Neurological Deterioration in Single Subcortical Infarction Without Any Relevant Artery Stenosis
Abstract:Objectives:
This study aimed to assess image biomarkers of early neurological deterioration in single subcortical infarction (SSI) without any relevant artery stenosis.
Methods:
Between June 2005 and December 2009, consecutive patients with SSI within 24 h of symptom onset were enrolled. Magnetic resonance angiography of the brain and neck was obtained from all patients to confirm the absence of any stenosis of relevant arteries. We defined early neurological deterioration (E… Show more
“…Studies have shown that larger infarct size or lower pons lesions may be associated with a higher probability of progressive motor deficits in patients with basilar artery branch disease (11,28,29). The longitudinal length of the infarcted lesion along the perforating artery was also reported to be associated with END in single subcortical infarction (10). However, there are few studies on the serum markers of END in BAD-stroke patients.…”
Section: Discussionmentioning
confidence: 98%
“…In our study, we observed that approximately 24.1% of the BAD-stroke patients experienced END, which resulted in more severe disability on discharge and higher 3-month MRS scores than the patients without END. Most of the previous studies on predictions of END in patients have focused on imaging features (8)(9)(10)(11)(12)28). Studies have shown that larger infarct size or lower pons lesions may be associated with a higher probability of progressive motor deficits in patients with basilar artery branch disease (11,28,29).…”
Section: Discussionmentioning
confidence: 99%
“…One large study found that the incidence of BAD in ischaemic stroke was 9.74%; however, the incidence of END was as high as 39.4% (7). Previous studies have shown that early neurological deterioration (END) in BAD patients is associated with various factors, such as infarct size, infarct location, female sex, severe neurological deficit, and platelet parameters (4, [8][9][10][11][12]. Given the strong association between END and long-term clinical outcome, the END had been the most attentive clinical problem in BAD.…”
Background and objectiveBranch atheromatous disease (BAD) makes patients prone to early neurological deterioration (END), resulting in poor prognosis. The aim of this study was to investigate the association between SUA/SCr and END in BAD stroke patients.MethodsWe conducted a retrospective study that included 241 patients with BAD-stroke within 48 h of symptom onset. We divided the patients into the END group and the no END group. END was defined as an NIHSS score increase of more than 2 points within 1 week. SUA/SCr was calculated by the concentration of serum uric acid and creatine (serum uric acid/serum creatine) on admission. Univariate and multivariate analyses were used to identify independent predictors of END in BAD-stroke patients.ResultsEND was observed in 24.1% (58/241) of the patients in our study. Multiple logistic regression analyses showed that SUA/SCr (aOR, 0.716; 95% CI, 0.538–0.952; P = 0.022) and female sex (aOR, 0.469; 95% CI, 0.245–0.898; P = 0.022) were associated with END after adjusting for confounding factors. The predicted value of SUA/Scr for END was a sensitivity of 79.3%, a specificity of 44.8%, and an AUC of 0.609 (95% CI, 0.527–0.691, P < 0.05). The optimal cut-off value was 4.76.ConclusionSUA/SCr was negatively associated with the risk of END in BAD stroke patients.
“…Studies have shown that larger infarct size or lower pons lesions may be associated with a higher probability of progressive motor deficits in patients with basilar artery branch disease (11,28,29). The longitudinal length of the infarcted lesion along the perforating artery was also reported to be associated with END in single subcortical infarction (10). However, there are few studies on the serum markers of END in BAD-stroke patients.…”
Section: Discussionmentioning
confidence: 98%
“…In our study, we observed that approximately 24.1% of the BAD-stroke patients experienced END, which resulted in more severe disability on discharge and higher 3-month MRS scores than the patients without END. Most of the previous studies on predictions of END in patients have focused on imaging features (8)(9)(10)(11)(12)28). Studies have shown that larger infarct size or lower pons lesions may be associated with a higher probability of progressive motor deficits in patients with basilar artery branch disease (11,28,29).…”
Section: Discussionmentioning
confidence: 99%
“…One large study found that the incidence of BAD in ischaemic stroke was 9.74%; however, the incidence of END was as high as 39.4% (7). Previous studies have shown that early neurological deterioration (END) in BAD patients is associated with various factors, such as infarct size, infarct location, female sex, severe neurological deficit, and platelet parameters (4, [8][9][10][11][12]. Given the strong association between END and long-term clinical outcome, the END had been the most attentive clinical problem in BAD.…”
Background and objectiveBranch atheromatous disease (BAD) makes patients prone to early neurological deterioration (END), resulting in poor prognosis. The aim of this study was to investigate the association between SUA/SCr and END in BAD stroke patients.MethodsWe conducted a retrospective study that included 241 patients with BAD-stroke within 48 h of symptom onset. We divided the patients into the END group and the no END group. END was defined as an NIHSS score increase of more than 2 points within 1 week. SUA/SCr was calculated by the concentration of serum uric acid and creatine (serum uric acid/serum creatine) on admission. Univariate and multivariate analyses were used to identify independent predictors of END in BAD-stroke patients.ResultsEND was observed in 24.1% (58/241) of the patients in our study. Multiple logistic regression analyses showed that SUA/SCr (aOR, 0.716; 95% CI, 0.538–0.952; P = 0.022) and female sex (aOR, 0.469; 95% CI, 0.245–0.898; P = 0.022) were associated with END after adjusting for confounding factors. The predicted value of SUA/Scr for END was a sensitivity of 79.3%, a specificity of 44.8%, and an AUC of 0.609 (95% CI, 0.527–0.691, P < 0.05). The optimal cut-off value was 4.76.ConclusionSUA/SCr was negatively associated with the risk of END in BAD stroke patients.
“…A binomial logistic regression model was utilized to assess the association between variables and END. The variables imported into the univariate regression analysis were obtained from characteristics with between-group differences in baseline data ( P ≤ 0.1) and the probable risk factors of END that were confirmed in previous studies [age, gender, location in corona radiata, infarction in internal capsule and brainstem [ 4 , 13 , 14 ]; BAD [ 12 ]; visible layers on DWI [ 15 ]; history of diabetes [ 16 ]; blood pressure on admission [ 17 ]; leukocyte count [ 18 ]; glucose [ 19 ]; hypertriglyceridemia [ 20 ]; D-dimer and uric acid [ 21 ]; BUN/CR ratio [ 22 ] and D-dimer [ 23 ]. A multivariate logistic regression model was used to analyze possible independent factors for END and poor function outcome at 3-month after the onset using variables with P ≤ 0.1 in the univariate analysis.…”
Objectives
This study aimed to assess the epidemiological features and explore the potential risk factors for early neurological deterioration (END) in patients with acute single small subcortical infarction (SSSI) who underwent antiplatelet therapy without carotid artery stenosis.
Materials & methods
Patients with SSSI, as confirmed by cranial magnetic resonance imaging (MRI), who were hospitalized within 48 h after the onset of symptoms were enrolled. END was mainly defined as increment in the National Institutes of Health Stroke Scale (NIHSS) score of ≥ 2 points or any new neurological deficit. Poor functional outcome was defined as modified Rankin Scale (mRS) score of > 2 points at 3-month after the onset. The association of END with multiple indicators was assessed at the early stage of admission using multivariate logistic regression analysis, and adjusted odds ratios (aORs) were calculated.
Results
A total of 280 patients were enrolled from June 2020 to May 2021, of whom, END occurred in 44 (15.7%) patients (median age, 64 years; 70.5% male), while END occurred during sleep in 28 (63.6%) patients. History of hypertension (aOR: 4.82, p = 0.001), infarction in internal capsule (aOR: 3.35, p = 0.001), and elevated level of low-density lipoprotein cholesterol (LDL-C; aOR: 0.036, p = 0.0016) were significantly associated with the risk of END. Patients with END (aOR: 5.74, p = 0.002), history of diabetes (aOR: 2.61, p = 0.020), and higher NIHSS scores at discharge (per 1-score increase, aOR: 1.29, p = 0.026) were associated with the poor functional outcome at 3-month after the onset.
Conclusion
Patients with a history of hypertension, infarction in internal capsule or a higher level of LDL-C were found to be at a higher risk of END.
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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