Topographic Location of Acute Pontine Infarction Is Associated With the Development of Progressive Motor Deficits

Oh, Se-Mi; Bang, Oh Young; Chung, Chin‐Sang; Chang, Won Hyuk; Kim, Gyeong-Moon

doi:10.1161/strokeaha.111.632307

Cited by 44 publications

(45 citation statements)

References 48 publications

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“…Lacunar strokes involving the pons commonly fluctuate 134 yet often lead to progressive worsening of deficits later. 135 Many patients with stroke with initial rapid improvement are ultimately disabled. 118,121,131 Early clinical improvement is a risk factor for subsequent deterioration in patients not treated with alteplase because of mild or improving stroke.…”

Section: Rapidly Improvingmentioning

confidence: 99%

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Demaerschalk¹,

Kleindorfer²,

Adeoye³

et al. 2016

Stroke

583

237

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Purpose-To critically review and evaluate the science behind individual eligibility criteria (indication/inclusion and contraindications/exclusion criteria) for intravenous recombinant tissue-type plasminogen activator (alteplase) treatment in acute ischemic stroke. This will allow us to better inform stroke providers of quantitative and qualitative risks associated with alteplase administration under selected commonly and uncommonly encountered clinical circumstances and to identify future research priorities concerning these eligibility criteria, which could potentially expand the safe and judicious use of alteplase and improve outcomes after stroke. Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge and, when appropriate, formulated recommendations using standard American Heart Association criteria. All members of the writing group had the opportunity to comment on and approved the final version of this document. The document underwent extensive American Heart Association internal peer review, Stroke The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on September 24, 2015, and the American Heart Association Executive Committee on October 5, 2015. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@ wolterskluwer.com.The online-only Data Supplement, which contains literature search strategies and Figures A, B, and C, is available with this article at http://circ. ahajournals.org/lookup/suppl/doi:10.1161/STR.0000000000000086/-/DC1.The American Heart Association requests that this document be cited as follows: Demaerschalk BM, Kleindorfer DO, Adeoye OM, Demchuk AM, Fugate JE, Grotta JC, Khalessi AA, Levy EI, Palesch YY, Prabhakaran S, Saposnik G, Saver JL, Smith EE; on behalf of the American Heart Association Stroke Council and Council on Epidemiology and Prevention. Scientific rational...

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Section: Rapidly Improvingmentioning

confidence: 99%

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Demaerschalk¹,

Kleindorfer²,

Adeoye³

et al. 2016

Stroke

583

237

View full text Add to dashboard Cite

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“…However, we mostly faced patients without any stenosis in magnetic resonance angiography (MRA) both in PPI and LPI patients. Additionally, despite the small size of the infarct, early neurological deterioration (END) is not uncommon in isolated pontine infarction (up to 30%) [2,3] .…”

Section: Introductionmentioning

confidence: 99%

Severe White Matter Hyperintensity Is Associated with Early Neurological Deterioration in Patients with Isolated Pontine Infarction

et al. 2016

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Objective: Pontine infarction is a common type of brain stem infarction and early neurological deterioration (END). We evaluated the possibility of severe white matter hyperintensity (WMH) as a predictor of END in isolated pontine infarction. Methods: We recruited 2 types of patients with isolated pontine infarction within 24 h from symptom onset. END was defined as an increase of ≥1 point on the motor National Institutes of Health Stroke Scale (NIHSS) or ≥2 points on the total NIHSS score within 72 h from admission. We graded WMH using Fazekas scale, which is dichotomized into mild (grades 0-1) and moderate to severe (grades 2-3) on fluid-attenuated inversion recovery images. Results: A total of 82 patients with an isolated pontine infarction were selected. END was detected in 23 patients (28%). Severe periventricular and subcortical WMH (PVWMH and SCWMH, respectively) were more frequent in deteriorating patients (p = 0.001 and p = 0.019, respectively). A logistic regression analysis revealed that both severe PVWMH (OR 6.17; 95% CI 1.93-19.75, p = 0.002) and SCWMH (OR 3.19; 95% CI 1.10-9.23, p = 0.032) remained independent predictors of END. Conclusions: Both severe PVWMH and SCWMH were useful to predict END in patients with isolated pontine infarction.

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“…Previous studies have usually been limited to retrospective data collection and smaller sample sizes. 5,8,[10][11][12]14,16,[27][28][29][30] From our research experience in collecting the acute complications of acute stroke cases, 21 we established detailed definitions and protocols about END and successfully implemented these into our daily clinical practice. When a nursing staff member or duty resident detected END, the information was readily spread via a texting service to the on-duty doctors and attending physicians.…”

mentioning

confidence: 99%

“…4,[8][9][10][11][12][13][14][15][16] However, these studies were conflicting and mostly conducted in a retrospective manner. A potential breakthrough about this issue may come from a detailed analysis of imaging findings that implicate 2 different pathological processes that contribute to the occurrence of SSSIs.…”

mentioning

confidence: 99%

Neuroimaging Markers for Early Neurologic Deterioration in Single Small Subcortical Infarction

Jeong

Kim

Yang

et al. 2015

Stroke

118

110

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A total of 4961 patients with stroke were admitted to Seoul National University Bundang Hospital between July 2007 and July 2013. Among them, the authors collected analyzable cases using the following inclusion criteria, such as (1) arrived within 48 hours after Background and Purpose-Early neurological deterioration (END) occurs in ≥20% of single small subcortical infarctions (SSSIs; axial diameter ≤20 mm in the perforator territories) and deters functional recovery. Both microvasculopathies and atherosclerosis have been proposed to independently contribute to the occurrence of END in SSSI cases. We hypothesized that the occurrence of END in SSSIs differs according to the pathological process. Methods-We collected data from 587 patients with SSSI within 48 hours of onset from a prospective stroke registry containing 4961 case records. Independent reviewers, blinded to END information, rated neuroimaging characteristics, including relevant artery stenosis (0% to 50% stenosis of the adjacent arteries on magnetic resonance angiography), branch atheromatous lesions (≥4 consecutive axial cuts or extensions from the basal surface of the pons), white matter hyperintensities, old lacunar infarctions, and cerebral microbleeds. Results-END occurred in 79 (13.5%) cases, including 6 recurrences, 68 progressions, 1 symptomatic hemorrhagic transformation, 1 others, and 3 unknowns. END increased the National Institutes of Health Stroke Scale score by 2.3±1.4 points. Patients with END showed higher frequencies of modified Rankin Scale scores of 3 to 6 after 3 months compared with patients without END (49% versus 23%). Patients with relevant artery stenosis (adjusted odds ratio, 1.91; 95% confidence interval, 1.13-3.21) and branch atheromatous lesions (adjusted odds ratio, 2.98; 95% confidence interval, 1.80-4.93) had significantly higher odds of exhibiting END. However, such an association was not detected with small vessel disease markers. Conclusions-Our analysis indicated a potential contribution of the localized atherosclerotic process to END in SSSIs.Precautionary measures might be used for Definition of Clinical InformationWe collected baseline demographic and clinical information for all study participants, including age, sex, body mass index, initial systolic and diastolic blood pressure, history of previous stroke, and cardiovascular risk factors such as hypertension (previous use of antihypertensive medication, systolic blood pressure >140 mm Hg, or diastolic blood pressure >90 mm Hg at discharge), diabetes mellitus (previous use of glucose-lowering medication or hemoglobin A1c ≥6.5%), hyperlipidemia (previous use of lipid-lowering medication, fasting low-density lipoprotein cholesterol >160 mg/dL, or fasting total cholesterol >240 mg/dL), and habitual smoking (current or past regular smoking). [18][19][20] We obtained laboratory information, including initial glucose level, hemoglobin A1c, total cholesterol, high-density lipoprotein cholesterol, triglycerides, low-density lipoprotein cholesterol, leukocyte count, h...

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Topographic Location of Acute Pontine Infarction Is Associated With the Development of Progressive Motor Deficits

Cited by 44 publications

References 48 publications

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Severe White Matter Hyperintensity Is Associated with Early Neurological Deterioration in Patients with Isolated Pontine Infarction

Neuroimaging Markers for Early Neurologic Deterioration in Single Small Subcortical Infarction

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