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Song L, Lou X, Han W, Yang L, Guo S, Jiang Y, Peng H, Hao Y. Predictors for unfavorable prognosis after stroke with perforator artery disease. Front Neurol 2024; 15:1340085. [PMID: 38327626 PMCID: PMC10847328 DOI: 10.3389/fneur.2024.1340085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/04/2024] [Indexed: 02/09/2024] Open
Abstract
Background and purpose Perforator artery disease (PAD) is an important subtype of ischemic stroke. The risk factors affecting the prognosis of patients with PAD are unclear. This study aimed to investigate the risk factors affecting the unfavorable prognosis of PAD. Methods Patients with PAD were enrolled from Dushu Lake Hospital Affiliated to Soochow University and diagnosed as stroke with PAD during the period from September 2021 to July 2023 and followed up with a modified Rankin Scale (mRS) after 90 days, defining the mRS of 0-2 as a group with favorable prognosis, and 3-6 as a group with unfavorable functional outcome. Logistic regression was used to identify predictors for PAD. Multiple logistic regression analysis and receiver operating characteristics (ROC) were used to identify predictors of unfavorable prognosis. Results Of the 181 enrolled patients, 48 (26.5%) were identified with unfavorable prognosis. On multivariate analysis, increased age (OR = 1.076, 95% CI: 1.012 ~ 1.144, p = 0.019), higher National Institutes of Health Stroke Scale (NIHSS) score at admission (OR = 2.930, 95% CI: 1. 905 ~ 4.508, p < 0.001), and increased neutrophil-to-lymphocyte ratio (NLR) (OR = 3.028, 95% CI: 1.615 ~ 5.675, p = 0.001) were independent risk factors for unfavorable prognosis in patients with PAD, and the area under the receiver operating characteristic curve was 0.590, 0.905, and 0.798, and the multi-factor diagnostic model (Model 2) showed reliable diagnostic specificity and sensitivity (area under the curve = 0.956, p < 0.001, specificity 0.805, sensitivity 0.958, accuracy 0.845). Conclusion Increased baseline NLR and NIHSS score and aging may be independent risk factors for unfavorable prognosis of patients with PAD. NLR can be used as a potential biological indicator to predict the prognosis of stroke with PAD.
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Affiliation(s)
- Linghua Song
- Suzhou Dushu Lake Hospital, Suzhou, Jiangsu, China
| | - Xiaoli Lou
- Suzhou Dushu Lake Hospital, Suzhou, Jiangsu, China
| | - Wenhao Han
- Suzhou Dushu Lake Hospital, Suzhou, Jiangsu, China
| | - Lihui Yang
- Suzhou Dushu Lake Hospital, Suzhou, Jiangsu, China
| | - Siping Guo
- Suzhou Dushu Lake Hospital, Suzhou, Jiangsu, China
| | - Yasi Jiang
- Suzhou Dushu Lake Hospital, Suzhou, Jiangsu, China
| | - Hao Peng
- School of Public Health, Soochow University Medical College, Suzhou, Jiangsu, China
| | - Yonggang Hao
- Suzhou Dushu Lake Hospital, Suzhou, Jiangsu, China
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Zhao M, Zhong X, Du J, He L, Wang J. Predictive factors for early neurological deterioration after intravenous thrombolysis of single subcortical infarction in the territory of the middle cerebral artery. Brain Behav 2023; 13:e3283. [PMID: 37849437 PMCID: PMC10726762 DOI: 10.1002/brb3.3283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023] Open
Abstract
INTRODUCTION Patients with a single subcortical infarction (SSI) in the territory of the middle cerebral artery (MCA) often experience early neurological deterioration (END) despite receiving intravenous thrombolytic therapy (IVT). In this study, predictors of END were investigated in patients with SSI in the MCA after IVT. METHODS Patients with SSI in the MCA territory who had received IVT between June 2020 and 2022 were included. END was defined as an increase in the total National Institutes of Health Stroke Scale (NIHSS) score by ≥2 or in the motor NIHSS score by ≥1 within the first 72 h of admission. Patients with proximal (pSSI) and distal SSI (dSSI) were analyzed to determine SSI type-specific predictors for END. RESULTS We evaluated 174 patients with SSI in the MCA territory who underwent IVT. Multivariable logistic regression analysis showed that pSSI (odds ratio [OR] = 0.242; 95% confidence interval [CI], 0.104-0.564; p = .001), lower high-density lipoprotein cholesterol (HDL-C) (OR = 0.150; 95% CI, 0.033-0.682; p = .014), higher blood glucose (OR = 0.858; 95% CI, 0.752-0.979; p = .023), and higher red blood cells count (OR = 1.966; 95% CI, 1.154-3.349; p = .013) were risk factors for END. In patients with pSSI, HDL-C and blood glucose were associated with END. No variable related to END was found in the dSSI group. CONCLUSIONS The proportion of END in patients with SSI in the MCA territory after IVT was not low; therefore, pSSI, HDL-C, blood glucose, and red blood cells should be monitored closely. The frequency and predictors of SSI in the MCA territory differed between pSSI and dSSI.
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Affiliation(s)
- Meng Zhao
- Department of NeurologyZhengzhou People's HospitalZhengzhouChina
| | - Xuemin Zhong
- Department of NeurologyThe Second People's Hospital of ChengduChengduChina
| | - Jiaxiu Du
- Department of NeurologyZhengzhou People's HospitalZhengzhouChina
| | - Lanying He
- Department of NeurologyThe Second People's Hospital of ChengduChengduChina
| | - Jian Wang
- Department of NeurologyThe Second People's Hospital of ChengduChengduChina
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Deguchi I, Osada T, Takahashi S. Efficacy of Treatment with and without Initial Clopidogrel Loading in Branch Atheromatous Disease. Intern Med 2023; 62:2959-2964. [PMID: 36889709 PMCID: PMC10641194 DOI: 10.2169/internalmedicine.1209-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/01/2023] [Indexed: 03/09/2023] Open
Abstract
Objective Despite aggressive therapeutic interventions during the acute phase of branch atheromatous disease (BAD)-type cerebral infarction, many patients, even those with a mild condition at the onset, experience neurological deterioration after hospitalization and develop serious deficits. We compared the therapeutic efficacy of multiple antithrombotic therapies for BAD between patients who received a clopidogrel loading dose (loading group; LG) and those without loading (non-loading group; NLG). Patients Between January 2019 and May 2022, patients with BAD-type cerebral infarction in the lenticulostriate artery admitted within 24 h of the onset were recruited. This study included 95 consecutive patients who received combination argatroban and dual antiplatelet therapy (aspirin and clopidogrel). Methods Patients were classified into the LG and NLG according to whether or not a loading dose of clopidogrel (300 mg) had been administered on admission. Changes in neurological severity [National Institutes of Health Stroke Scale (NIHSS) score] during the acute phase were retrospectively evaluated. Results There were 34 (36%) and 61 (64%) patients in the LG and NLG, respectively. On admission, the median NIHSS score was similar between the groups [LG: 2.5 (2-4) vs. NLG: 3 (2-4), p=0.771]. At 48 h following admission, the median NIHSS scores were 1 (0.25-4), and 2 (1-5) in the LG and NLG, respectively (p=0.045). Early neurological deterioration (END; defined as worsening of the NIHSS score by ≥4 points at 48 h after admission) occurred in 3% of LG and 20% of NLG patients (p=0.028). Conclusion Administration of a clopidogrel loading dose with combination antithrombotic therapy for BAD reduced END.
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Affiliation(s)
- Ichiro Deguchi
- Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Japan
| | - Takashi Osada
- Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Japan
| | - Shinichi Takahashi
- Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Japan
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Yang Y, Si Z, Wang D, Dong D, Liu R, Yu X, Tang J, Wang A. The "island sign" on diffusion-weighted imaging predicts early neurological deterioration in penetrating artery territory infarctions: a retrospective study. BMC Neurol 2023; 23:298. [PMID: 37568140 PMCID: PMC10416470 DOI: 10.1186/s12883-023-03351-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Early neurological deterioration (END) sometimes occurs in patients with penetrating artery territory infarction (PATI) and leads to poor prognosis. In this study, we analyzed clinical and neuroimaging characteristics of PATI, and focused on the infarct patterns on diffusion-weighted imaging (DWI). We tried to investigate whether the "island sign" pattern is associated with END. METHODS We enrolled consecutive patients admitted with acute PATI within 48 h after onset from May 2020 to July 2022. They were divided into with and without the "island sign" pattern on DWI. According to infarct location, all the patients were classified into two groups: the territories of the lenticulostriate arteries (LSA) and paramedian pontine arteries (PPA). The patients in each group were further divided into two groups according to whether they developed END or not. Through analyzing the clinical and neuroimaging characteristics of the patients, we tried to identify the factors that might associated with the "island sign" pattern and the potential predictors of END within the LSA and PPA groups. RESULTS Out of the 113 patients enrolled in this study, END was found in 17 patients (27.9%) in the LSA group and 20 patients (38.5%) in the PPA group. The "island sign" was found in 26 (23%) patients. In the multivariate analysis, the independent predictors of END in the LSA group were the "island sign" (OR 4.88 95% CI 1.03-23.2 P = 0.045) and high initial National Institute of Health Stroke Scale (NIHSS) (OR 1.79 95% CI 1.08-2.98 P = 0.024) and in the PPA group was the presence of lesions extending to the ventral pontine surface (OR 7.53 95% CI 1.75-32.37 P = 0.007). CONCLUSIONS The predictive factors for END were different in the LSA and PPA groups. The "island sign" was particularly associated with END in the LSA group.
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Affiliation(s)
- Yang Yang
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, No. 16766 Jingshi Road, Jinan, 250013, Shandong, China
- Department of Neurology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, No. 16766 Jingshi Road, Jinan, 250013, Shandong, China
| | - Zhihua Si
- Department of Neurology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, No. 16766 Jingshi Road, Jinan, 250013, Shandong, China
| | - Dawei Wang
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, No. 16766 Jingshi Road, Jinan, 250013, Shandong, China
| | - Dong Dong
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, No. 16766 Jingshi Road, Jinan, 250013, Shandong, China
| | - Rutao Liu
- Department of Neurology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, No. 16766 Jingshi Road, Jinan, 250013, Shandong, China
| | - Xianwen Yu
- Department of Neurology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, No. 16766 Jingshi Road, Jinan, 250013, Shandong, China
| | - Jiyou Tang
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, No. 16766 Jingshi Road, Jinan, 250013, Shandong, China.
- Department of Neurology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, No. 16766 Jingshi Road, Jinan, 250013, Shandong, China.
| | - Aihua Wang
- Department of Neurology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, No. 16766 Jingshi Road, Jinan, 250013, Shandong, China.
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Senda J, Ito K, Kotake T, Mizuno M, Kishimoto H, Yasui K, Katsuno M, Nishida Y, Sobue G. Investigation of inpatient convalescent rehabilitation outcomes in branch atheromatous disease. J Stroke Cerebrovasc Dis 2023; 32:106937. [PMID: 36621120 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 01/09/2023] Open
Abstract
PURPOSE We investigated inpatient convalescent rehabilitation outcomes of Branch atheromatous disease (BAD). SUBJECTS AND METHODS The subjects were 116 patients with lenticulostriate artery territory - BAD (LSA-BAD) and 29 with paramedian pontine artery territory - BAD (PPA-BAD). For all patients, the National Institutes of Health Stroke Scale (NIHSS), Functional Independence Measure (FIM) scores, and Brunnstrom recovery stages (BRS) of the upper limb, fingers, and lower limb were measured on admission and at discharge. RESULTS There were no significant differences in clinical characteristics on admission between the LSA-BAD and PPA-BAD groups. The neurological severity of PPA-BAD, as measured by the NIHSS, was significantly milder compared with that of LSA-BAD upon admission (p = 0.015) and at discharge (p = 0.001). Patients with LSA-BAD had significantly less improvement in the BRS of the upper limb (p = 0.001), fingers (p < 0.001), and lower limb (p = 0.007) at discharge. Furthermore, they had significantly smaller changes in BRS between admission and discharge for the upper limb (p = 0.033) and fingers (p = 0.014) compared with patients with PPA-BAD. The improvement in BRS for patients with LSA-BAD tended to be limited to two stages; however, both patients with LSA-BAD and PPA-BAD saw sufficient gains in FIM at discharge. CONCLUSION Rehabilitation outcomes following BAD in the convalescent period should be assessed in terms of improvements in pure-motor hemiparesis and activities of daily living. Furthermore, the disturbance patterns in the corticospinal tract by ischemic stroke lesions may be different between LSA-BAD and PPA-BAD.
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Affiliation(s)
- Joe Senda
- Department of Neurology and Rehabilitation, Komaki City Hospital, Komaki, Japan; Division of Rehabilitation, Kami-iida Rehabilitation Hospital, Nagoya, Japan.
| | - Keiichi Ito
- Division of Rehabilitation, Kami-iida Rehabilitation Hospital, Nagoya, Japan
| | - Tomomitsu Kotake
- Division of Rehabilitation, Kami-iida Rehabilitation Hospital, Nagoya, Japan; Department of Physiology, Graduate School of Health Sciences, Toyohashi Sozo University, Toyohashi, Japan
| | - Masanori Mizuno
- Division of Rehabilitation, Kami-iida Rehabilitation Hospital, Nagoya, Japan
| | - Hideo Kishimoto
- Division of Rehabilitation, Kami-iida Rehabilitation Hospital, Nagoya, Japan
| | - Keizo Yasui
- Department of Neurology, Japanese Red Cross Aichi Medical Center Nagoya Second Hospital, Nagoya, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshihiro Nishida
- Division of Rehabilitation, Nagoya University Hospital, Nagoya, Japan; Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Gen Sobue
- Graduate School of Medicine, Aichi Medical School, Nagakute, Japan
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Jin D, Yang J, Zhu H, Wu Y, Liu H, Wang Q, Zhang X, Dong Y, Luo B, Shan Y, Zhang L, Wang P, Du J. Risk factors for early neurologic deterioration in single small subcortical infarction without carrier artery stenosis: predictors at the early stage. BMC Neurol 2023; 23:83. [PMID: 36849878 PMCID: PMC9969648 DOI: 10.1186/s12883-023-03128-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/16/2023] [Indexed: 03/01/2023] Open
Abstract
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.
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Affiliation(s)
- Di Jin
- grid.464204.00000 0004 1757 5847Department of Neurology, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049 People’s Republic of China
| | - Jing Yang
- grid.464204.00000 0004 1757 5847Department of Neurology, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049 People’s Republic of China
| | - Hui Zhu
- grid.464204.00000 0004 1757 5847Department of Neurology, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049 People’s Republic of China
| | - Yuexia Wu
- grid.256883.20000 0004 1760 8442Graduate School of the First Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Haichao Liu
- grid.464204.00000 0004 1757 5847Department of Neurology, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049 People’s Republic of China
| | - Qi Wang
- grid.464204.00000 0004 1757 5847Department of Neurology, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049 People’s Republic of China
| | - Xiaoyun Zhang
- grid.464204.00000 0004 1757 5847Department of Neurology, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049 People’s Republic of China
| | - Yanhua Dong
- grid.464204.00000 0004 1757 5847Department of Neurology, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049 People’s Republic of China
| | - Bin Luo
- grid.464204.00000 0004 1757 5847Department of Neurology, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049 People’s Republic of China
| | - Yong Shan
- grid.464204.00000 0004 1757 5847Department of Neurology, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049 People’s Republic of China
| | - Lvming Zhang
- grid.464204.00000 0004 1757 5847Department of Neurology, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049 People’s Republic of China
| | - Peifu Wang
- grid.464204.00000 0004 1757 5847Department of Neurology, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049 People’s Republic of China
| | - Jichen Du
- Department of Neurology, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049, People's Republic of China.
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Factors associated with two different stroke mechanisms in perforator infarctions regarding the shape of arteries. Sci Rep 2022; 12:16752. [PMID: 36202949 PMCID: PMC9537294 DOI: 10.1038/s41598-022-21329-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 09/26/2022] [Indexed: 11/08/2022] Open
Abstract
Two different stroke mechanisms are involved in small vessel disease: branch atheromatous disease (BAD) and lipohyalinotic degeneration (LD). We compared mechanisms of stroke in lenticulostriate arteries (LSA) vs. anterior pontine arteries (APA) and verified factors associated with stroke mechanisms, including shape of middle cerebral artery (MCA) and basilar artery (BA). We retrospectively reviewed patients with acute ischemic stroke with penetrating artery territory confirmed by MRI. The mechanisms of stroke were categorized based on diffusion-weighted imaging; BAD was defined as lesion larger than 10 mm in LSA and lesions involving basal pontine in APA. Other lesions were classified as LD. The shapes of MCA and BA were classified as straight, with one angle, or with two angles (U, C or S shape, respectively) using anterior-posterior view. The study included 221 patients. LD was more common in LSA infarcts, but BAD was more common in APA infarcts (p < 0.001). Low initial National Institutes of Health Stroke Scale [Adjusted Odds ratio (aOR) = 0.78; p < 0.001], absence of hyperlipidemia [aOR = 0.31; p = 0.002], previous statin use [aOR = 4.35; p = 0.028] LSA infarcts [reference = APA territory; aOR = 11.07; p < 0.001], and S-shaped vessels (reference = straight shaped vessels; aOR = 3.51; p = 0.004) were independently associated with LD. Angulations in the mother vessels may be more associated with true small vessel disease more with LD than BAD.
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Liu Y, Peng H, Wang J, He L, Xu J, Zheng M, Xu Y, Xu F. Risk factors for early neurological deterioration in acute isolated pontine infarction without any causative artery stenosis. BMC Neurol 2022; 22:332. [PMID: 36057555 PMCID: PMC9440546 DOI: 10.1186/s12883-022-02861-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
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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Affiliation(s)
- Yinglin Liu
- Department of Neurology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610011, People's Republic of China
| | - Hongmei Peng
- Department of Neurology, Chengdu Qingbaijiang District People's Hospital, Chengdu, Sichuan, 610300, People's Republic of China
| | - Jian Wang
- Department of Neurology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610011, People's Republic of China
| | - Lanying He
- Department of Neurology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610011, People's Republic of China
| | - Jinghan Xu
- Department of Neurology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610011, People's Republic of China
| | - Min Zheng
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People's Republic of China
| | - Yao Xu
- Department of Radiology, Pingshan County People's Hospital, Yibin, Sichuan, 644000, People's Republic of China
| | - Fan Xu
- Department of public Health, Chengdu Medical College, No. 601 Tianhui Street, JinniuDistrict, Chengdu, Sichuan, 610500, People's Republic of China.
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Saima B, Mikel T, Maria B, Yolanda S, Juan ÁC, Victor VM, Laura P, Montserrat R, Carme GM, Alan M, Joaquín S. Progressive Lacunar Atrokes: A Predictive Score. J Stroke Cerebrovasc Dis 2022; 31:106510. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 04/01/2022] [Accepted: 04/08/2022] [Indexed: 02/05/2023] Open
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Kobayashi Y, Okumura G, Morizumi T, Nagamatsu K, Shimizu Y, Sasaki T, Sato A, Sekijima Y, Hongo K. Scattered cerebral infarction in the corona radiata predicts worse outcomes. Acta Neurol Scand 2022; 146:70-74. [PMID: 35428977 DOI: 10.1111/ane.13623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/24/2022] [Accepted: 04/06/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Intracranial branch atheromatous disease often results in progressive motor deficits in the lenticulostriate arteries (LSA). In some patients with LSA infarction, magnetic resonance imaging (MRI) revealed single lesions at the LSA origin from the middle cerebral artery spreading in a scattered manner toward the distal area. This study aimed to elucidate the clinical characteristics of such cases. MATERIALS AND METHODS This was a single-center, retrospective study comprising 1,840 consecutive patients admitted to the Ina Central Hospital, Japan. Two neurologists selected patients with LSA infarctions on the basis of MRI data. Patients with a single mass of infarct lesion from the origin were classified as the single group, whereas patients with infarct lesions as a single mass at LSA origin but divided and independent as the infarct area extended distally were classified as the scattered group. We compared the clinical characteristics and outcomes in these groups. RESULTS The single and scattered groups included 119 and 35 patients, respectively. We defined worsening as an increase of one point or more on the National Institute of Health Stroke Scale. Univariate analysis demonstrated that patients in the scattered group showed significantly more worsening after hospitalization compared with those in the single group (48.6% vs. 28.6%; p < .05). Moreover, this can easily lead to increased disease severity (p < .016). In a multivariate analysis, group (odds ratio, 2.5 [95% CI, 1.11-5.74], p < .03) was an independent predictor of symptom worsening. CONCLUSIONS Scattered infarction in the corona radiata is an aggravating factor leading to worse outcomes.
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Affiliation(s)
| | - Gaku Okumura
- Department of Neurology Ina Central Hospital Ina Japan
| | | | | | | | - Tetsuo Sasaki
- Department of Neurosurgery Ina Central Hospital Ina Japan
| | - Atsushi Sato
- Department of Neurosurgery Ina Central Hospital Ina Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology & Rheumatology) Shinshu University School of Medicine Matsumoto Japan
| | - Kazuhiro Hongo
- Department of Neurosurgery Ina Central Hospital Ina Japan
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Oge DD, Topcuoglu MA, Arsava EM. Apparent diffusion coefficient signature of ischemic tissue predicts neurological progression in isolated pontine infarcts. Eur Stroke J 2022; 7:66-70. [PMID: 35300260 PMCID: PMC8921789 DOI: 10.1177/23969873211072956] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/17/2021] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Early neurological deterioration is encountered in up to a third of patients with isolated pontine infarcts. A limited number of clinical and imaging features have been suggested as predictors of neurological progression in this setting. In this study, we assessed whether quantitative apparent diffusion coefficient (ADC) measurements within the ischemic pontine region could be used as a radiomic feature to forecast clinical deterioration. METHODS We calculated the mean ADC value of ischemic voxels within the ischemic region and normalized them to the contralateral non-ischemic tissue (relative ADC, rADC) in patients with isolated pontine infarcts. This imaging signature was then compared among patients with neurological progression (n = 21) and a propensity matched cohort of non-progressors (n = 42), together with other clinical and imaging features in bivariate and multivariate statistical models. RESULTS The rADCmean was significantly lower among patients with progression (p = 0.008). Female gender and extension of the ischemic lesion to the ventral pontine surface were other features significantly associated with progression. The association between rADCmean and progression persisted in multivariate models with an odds ratio of 13.7 (95% CI 2.6-72.8; p = 0.002) for progression among patients with rADCmean ≤ 0.67 in their ischemic tissue. The probability for worsening was 80% among patients who had an ischemic lesion extending to the ventral pontine surface with a mean rADC ≤ 0.67. CONCLUSION The mean rADC value within the ischemic lesion is closely related with early neurological deterioration in patients with isolated pontine infarcts.
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Affiliation(s)
- Dogan Dinc Oge
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet A. Topcuoglu
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ethem Murat Arsava
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Vynckier J, Maamari B, Grunder L, Goeldlin MB, Meinel TR, Kaesmacher J, Hakim A, Arnold M, Gralla J, Seiffge DJ, Fischer U. Early Neurologic Deterioration in Lacunar Stroke: Clinical and Imaging Predictors and Association With Long-term Outcome. Neurology 2021; 97:e1437-e1446. [PMID: 34400585 DOI: 10.1212/wnl.0000000000012661] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 07/06/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To determine the rate and predictors of early neurologic deterioration (END) in patients with lacunar strokes and its implications for management and outcome. METHODS We enrolled consecutive patients with MRI-defined lacunar stroke who presented within 12 hours after symptom onset from a prospective stroke database (2015-2019). END was defined as any persisting increase in NIH Stroke Scale (NIHSS) score of ≥2 points within 24 hours after admission and favorable outcome as modified Rankin Scale (mRS) score of 0 to 2 at 90 days. We assessed the association of END with clinical and imaging variables, acute treatment, and outcome using multivariable regression, calculating adjusted odds ratios (aORs). RESULTS Sixty-one of 365 (16.7%) patients with acute lacunar stroke (median age 71.8 years, 39.5% female, median NIHSS score on admission 3) had END. Lower NIHSS score on admission (per point, aOR 0.81, p = 0.006), capsular warning syndrome (aOR 7.00, p < 0.001), ventral pontine infarct (aOR 3.49, p = 0.008), and hypoperfusion lesion on imaging (aOR 2.13, p = 0.026) were associated with END. Acute dual antiplatelet therapy was associated with reduced risk of END (aOR 0.10, p = 0.04). Patients with END had less favorable outcome at 90 days (aOR 0.13 p < 0.001), but IV thrombolysis (IVT) was associated with favorable outcome at 90 days (aOR 3.95, p = 0.002). DISCUSSION One in 6 patients with lacunar stroke has END, and patients at high risk of END can be identified with radiologic and clinical variables. Targeted therapeutic trials for this population seem justified. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that early neurologic deterioration in patients with acute lacunar stroke predicts poorer functional outcome at 90 days as determined by the mRS.
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Affiliation(s)
- Jan Vynckier
- From the Department of Neurology (J.V., B.M., L.G., M.B.G., T.R.M., J.K., M.A., J.G., D.J.S., U.F.), Institute of Diagnostic and Interventional Neuroradiology (L.G., J.K., A.H., J.G.), and Institute of Diagnostic Interventional and Pediatric Radiology (L.G., J.K., J.G.), Inselspital, Bern University Hospital and University of Bern, Switzerland.
| | - Basel Maamari
- From the Department of Neurology (J.V., B.M., L.G., M.B.G., T.R.M., J.K., M.A., J.G., D.J.S., U.F.), Institute of Diagnostic and Interventional Neuroradiology (L.G., J.K., A.H., J.G.), and Institute of Diagnostic Interventional and Pediatric Radiology (L.G., J.K., J.G.), Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Lorenz Grunder
- From the Department of Neurology (J.V., B.M., L.G., M.B.G., T.R.M., J.K., M.A., J.G., D.J.S., U.F.), Institute of Diagnostic and Interventional Neuroradiology (L.G., J.K., A.H., J.G.), and Institute of Diagnostic Interventional and Pediatric Radiology (L.G., J.K., J.G.), Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Martina Béatrice Goeldlin
- From the Department of Neurology (J.V., B.M., L.G., M.B.G., T.R.M., J.K., M.A., J.G., D.J.S., U.F.), Institute of Diagnostic and Interventional Neuroradiology (L.G., J.K., A.H., J.G.), and Institute of Diagnostic Interventional and Pediatric Radiology (L.G., J.K., J.G.), Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Thomas Raphael Meinel
- From the Department of Neurology (J.V., B.M., L.G., M.B.G., T.R.M., J.K., M.A., J.G., D.J.S., U.F.), Institute of Diagnostic and Interventional Neuroradiology (L.G., J.K., A.H., J.G.), and Institute of Diagnostic Interventional and Pediatric Radiology (L.G., J.K., J.G.), Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Johannes Kaesmacher
- From the Department of Neurology (J.V., B.M., L.G., M.B.G., T.R.M., J.K., M.A., J.G., D.J.S., U.F.), Institute of Diagnostic and Interventional Neuroradiology (L.G., J.K., A.H., J.G.), and Institute of Diagnostic Interventional and Pediatric Radiology (L.G., J.K., J.G.), Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Arsany Hakim
- From the Department of Neurology (J.V., B.M., L.G., M.B.G., T.R.M., J.K., M.A., J.G., D.J.S., U.F.), Institute of Diagnostic and Interventional Neuroradiology (L.G., J.K., A.H., J.G.), and Institute of Diagnostic Interventional and Pediatric Radiology (L.G., J.K., J.G.), Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Marcel Arnold
- From the Department of Neurology (J.V., B.M., L.G., M.B.G., T.R.M., J.K., M.A., J.G., D.J.S., U.F.), Institute of Diagnostic and Interventional Neuroradiology (L.G., J.K., A.H., J.G.), and Institute of Diagnostic Interventional and Pediatric Radiology (L.G., J.K., J.G.), Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Jan Gralla
- From the Department of Neurology (J.V., B.M., L.G., M.B.G., T.R.M., J.K., M.A., J.G., D.J.S., U.F.), Institute of Diagnostic and Interventional Neuroradiology (L.G., J.K., A.H., J.G.), and Institute of Diagnostic Interventional and Pediatric Radiology (L.G., J.K., J.G.), Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - David Julian Seiffge
- From the Department of Neurology (J.V., B.M., L.G., M.B.G., T.R.M., J.K., M.A., J.G., D.J.S., U.F.), Institute of Diagnostic and Interventional Neuroradiology (L.G., J.K., A.H., J.G.), and Institute of Diagnostic Interventional and Pediatric Radiology (L.G., J.K., J.G.), Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Urs Fischer
- From the Department of Neurology (J.V., B.M., L.G., M.B.G., T.R.M., J.K., M.A., J.G., D.J.S., U.F.), Institute of Diagnostic and Interventional Neuroradiology (L.G., J.K., A.H., J.G.), and Institute of Diagnostic Interventional and Pediatric Radiology (L.G., J.K., J.G.), Inselspital, Bern University Hospital and University of Bern, Switzerland
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Hong L, Ling Y, Su Y, Yang L, Lin L, Parsons M, Cheng X, Dong Q. Hemispheric cerebral blood flow predicts outcome in acute small subcortical infarcts. J Cereb Blood Flow Metab 2021; 41:2534-2545. [PMID: 34435912 PMCID: PMC8504947 DOI: 10.1177/0271678x211029884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The association between baseline perfusion measures and clinical outcomes in patients with acute small subcortical infarcts (SSIs) has not been studied in detail. Post-processed acute perfusion CT and follow-up diffusion-weighted imaging of 71 patients with SSIs were accurately co-registered. Relative perfusion values were calculated from the perfusion values of the infarct lesion divided by those of the mirrored contralateral area. The association between perfusion measures with clinical outcomes and the interaction with intravenous thrombolysis were studied. Additionally, the perfusion measures for patients having perfusion CT before and after thrombolysis were compared. Higher contralateral hemispheric cerebral blood flow (CBF) was the only independent predictor of an excellent clinical outcome (modified Rankin Scale of 0-1) at 3 months (OR = 1.3, 95% CI 1.1-1.4, P = 0.001) amongst all the perfusion parameters, and had a significant interaction with thrombolysis (P = 0.04). Patients who had perfusion CT after thrombolysis demonstrated a better perfusion profile (relative CBF ≥1) than those who had perfusion CT before thrombolysis (After:45.5%, Before:21.1%, P = 0.03). This study implies that for patients with SSIs, hemispheric CBF is a predictor of clinical outcome and has an influence on the effect of intravenous thrombolysis.
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Affiliation(s)
- Lan Hong
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Yifeng Ling
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Ya Su
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Lumeng Yang
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Longting Lin
- Department of Neurology, Liverpool Hospital, University of New South Wales South Western Sydney Clinical School, The Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Mark Parsons
- Department of Neurology, Liverpool Hospital, University of New South Wales South Western Sydney Clinical School, The Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Xin Cheng
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Qiang Dong
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
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Yamamoto Y, Nagakane Y, Tomii Y. [Cerebral deep vascular architectures and subcortical infarcts]. Rinsho Shinkeigaku 2020; 60:397-406. [PMID: 32435049 DOI: 10.5692/clinicalneurol.60.cn-001408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The lenticulostriate arteries (LSA) supply the lateral half of the head of the caudate nucleus, entire putamen, anterior limb, genu and the superior part of the internal capsule (IC) and a part of the corona radiata. The LSA consists with medial, intermediate and lateral branches. The medial branches perfuse the lateral segment of the globus pallidus, the head of the caudate nucleus and the anterior limb of the IC. The intermediate branches supply the anterior half of the LSA territory, while the lateral branches supply the posterior half. The anterior cerebral artery (ACA) perforators, predominantly Heubner's artery, perfuse the inferomedial part of the caudate head, the anteromedial part of putamen, the anterior part of the lateral segment of the globus pallidus and anterior limb of the internal capsule. Such territories can be represented by the anterior and ventral basal ganglions. The anterior choroidal artery (AChA) gives off three main groups of branches including the lateral branches that supply the medial temporal lobe, the medial branches that supply the cerebral peduncle and the superior branches that supply the internal capsule and the basal ganglia. The superior branches are further discriminated into proximal branches that supply the anterior one third of the posterior limb of internal capsule (PLIC) and the medial segment of the globus pallidus and distal branches that supply the posterior two-third of PLIC, retro-lenticular part of the internal capsule and the lateral thalamic nuclei. The superficial penetrating arteries, i.e. medullary arteries, arise from the cortical branches of the middle cerebral artery (MCA) and supply the deep white matter. Infarcts caused by the medullary artery occlusion are located in the centrum-semiovale and half of them were caused by embolic mechanism. The centrum-semiovale corresponds to cortical border-zone (BZ) while the corona radiate corresponds to internal BZ.
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15
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Yang L, Qin W, Li Y, Yang S, Gu H, Hu W. Differentiation of Pontine Infarction by Size. Open Med (Wars) 2020; 15:160-166. [PMID: 32190740 PMCID: PMC7065441 DOI: 10.1515/med-2020-0025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/06/2020] [Indexed: 11/15/2022] Open
Abstract
Purpose We hypothesized that the current criteria may be unsuitable for lacunar pontine infarctions (LPI) diagnosis and that size criteria may indicate different stroke mechanisms. Methods A total of 102 patients with isolated pontine infarctions were divided into a parent artery disease (PAD) and non-PAD groups according to stenosis of basilar artery. Further, 86 patients from the non-PAD group were divided into paramedian pontine infarction (PPI) and LPI groups. Data were collected from the three groups. The “golden” criterion for LPI was established based on the location of the infarction. A receiver operating characteristic (ROC) curve were used to evaluate the optimal cutoff value to use as an LPI diagnostic indicator. Results There was a high prevalence of patients with PAD in both asymptomatic carotid atherosclerosis (ACAS) and PPI groups. Patients with PPI had a higher prevalence in diabetes and ACAS than those with LPI. Based upon the ROC curve, the optimal lesion size cutoff value for use as an LPI diagnostic indicator was 11.8 mm. Conclusions Diffusion weighted imaging (DWI) cutoff points for predicting LPI may differ from that of the middle cerebral artery territory. The diameter of LPI may also indicate different stroke mechanisms.
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Affiliation(s)
- Lei Yang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, No. 8, South Gongti Road, Beijing 100020, China
| | - Wei Qin
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, No. 8, South Gongti Road, Beijing 100020, China
| | - Yue Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, No. 8, South Gongti Road, Beijing 100020, China
| | - Shuna Yang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, No. 8, South Gongti Road, Beijing 100020, China
| | - Hua Gu
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing China
| | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, No. 8, South Gongti Road, Beijing 100020, China
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16
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Berberich A, Schneider C, Herweh C, Hielscher T, Reiff T, Bendszus M, Gumbinger C, Ringleb P. Risk factors associated with progressive lacunar strokes and benefit from dual antiplatelet therapy. Eur J Neurol 2020; 27:817-824. [PMID: 31994783 DOI: 10.1111/ene.14159] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/22/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Early neurological deterioration (END) occurs in 20%-30% of patients with lacunar stroke and challenges their clinical management. This retrospective cohort study analyzed clinical and neuroimaging risk factors predicting the occurrence of END, the functional outcome after END and potential benefit from dual antiplatelet therapy (DAPT) in patients with lacunar strokes. METHODS Factors associated with END and benefit from DAPT were retrospectively analyzed in 308 patients with lacunar stroke symptoms and detected lacunar infarction by magnetic resonance imaging. END was defined by deterioration of ≥3 total National Institutes of Health Stroke Scale (NIHSS) points, ≥2 NIHSS points for limb paresis or documented deterioration within 5 days after admission. Patients were treated with DAPT according to in-house standards. The primary efficacy end-point for functional outcome was fulfilled if NIHSS at discharge improved after END at least to the score at admission. RESULTS Male gender [odds ratio (OR) 2.08; 95% confidence interval (CI) 1.09-4.00], higher age (OR = 1.65 per 10 years; 95% CI 1.18-2.31), motor paresis (OR = 18.89, 95% CI 4.66-76.57) and infarction of the internal capsule or basal ganglia (OR = 3.58, 95% CI 1.26-10.14) were associated with an increased risk for END. A larger diameter of infarction (OR = 0.85, 95% CI 0.76-0.95), more microangiopathic lesions (OR = 0.75, 95% CI 0.57-0.99) and pontine localization (OR = 0.29, 95% CI 0.12-0.65) were factors associated with unfavorable functional outcome after END occurred. Localization in the internal capsule or basal ganglia was identified as a significant predictive factor for a benefit from DAPT after END. CONCLUSIONS Identified clinical and neuroimaging factors predicting END occurrence, functional outcome after END and potential benefit from DAPT might improve the clinical management of patients with lacunar strokes.
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Affiliation(s)
- A Berberich
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - C Schneider
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - C Herweh
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - T Hielscher
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - T Reiff
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - M Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - C Gumbinger
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - P Ringleb
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
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Mantero V, Filizzolo M, Botto E, Giussani G, Aliprandi A, Basilico P, Scaccabarozzi C, Salmaggi A. Size, shape and location of lacunar strokes and correlation with risk factors. Clin Neurol Neurosurg 2020; 190:105665. [PMID: 31918381 DOI: 10.1016/j.clineuro.2020.105665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 12/09/2019] [Accepted: 01/01/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We evaluated a prospective cohort of 150 patients under observation in our centre for lacunar strokes. The purpose of this study was to investigate if lacunar stroke of varying size, shape and locations had different risk factors between them and possibly different mechanisms and causes. PATIENTS AND METHODS 150 patients with a lacunar stroke were included in the present study. Infarcts were classified by size, shape and location. We evaluated the correlation between several risk factors of stroke and the radiological characteristics of the infarcts. RESULTS Older age was associated with the presence of a basal ganglia lesion (p < 0.001) and with the presence of a smaller lesion (trend to statistical significance, p = 0.07). Patients with infarcts >15 mm had higher NIHSS score at admission (p 0.01). CONCLUSION The different subtypes of lacunar infarcts have distinct pathogenesis. Further studies, with a larger numbers of patients, are necessary to confirm our data.
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Affiliation(s)
- Vittorio Mantero
- Neurology - Stroke Unit, "A. Manzoni" Hospital, ASST Lecco, Lecco, Italy.
| | - Marco Filizzolo
- Neuroradiological Unit, "A. Manzoni" Hospital, ASST Lecco, Lecco, Italy
| | - Emanuela Botto
- Neurology - Stroke Unit, "A. Manzoni" Hospital, ASST Lecco, Lecco, Italy
| | - Giuditta Giussani
- Neurology - Stroke Unit, "A. Manzoni" Hospital, ASST Lecco, Lecco, Italy
| | - Angelo Aliprandi
- Neurology - Stroke Unit, "A. Manzoni" Hospital, ASST Lecco, Lecco, Italy
| | - Paola Basilico
- Neurology - Stroke Unit, "A. Manzoni" Hospital, ASST Lecco, Lecco, Italy
| | | | - Andrea Salmaggi
- Neurology - Stroke Unit, "A. Manzoni" Hospital, ASST Lecco, Lecco, Italy
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Gong P, Liu Y, Huang T, Chen W, Jiang T, Gong Y, Lu M, Wang M, Zhang Y, Zhang X, Deng Q, Zhou J. The association between high-sensitivity C-reactive protein at admission and progressive motor deficits in patients with penetrating artery infarctions. BMC Neurol 2019; 19:346. [PMID: 31884970 PMCID: PMC6935496 DOI: 10.1186/s12883-019-1538-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/21/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND A fraction of patients with penetrating artery infarction (PAI) experience progressive motor deficit deterioration (PMD). We sought to investigate the role of high-sensitivity C-reactive protein (hs-CRP) at admission in predicting PMD. METHODS From January 2015 to September 2018, consecutive patients with PAI from three centers were prospectively enrolled in this study. PMD was defined as worsening of motor function score by ≥1 point on the National Institutes of Health Stroke Scale during the first 5 days after admission. Multivariable logistic regression analyses were performed to explore the relationship between hs-CRP and PMD in patients with PAI. We also performed receiver operating characteristic curve analysis and constructed a nomogram to assess the overall discriminative ability of hs-CRP in predicting PMD. RESULTS We ultimately included 544 patients (mean age, 65.4 ± 11.8 years). A total of 85 (15.6%) patients were identified to have PMD. Multivariate logistic regression analysis showed that hs-CRP was independently associated with PMD (P = 0.001). The optimal cutoff value for hs-CRP as a predictor for PMD was 3.48 mg/L, with a sensitivity of 73.64% and a specificity of 82.35% (area under curve, 0.792). Moreover, the nomogram we constructed indicated that higher level of hs-CRP was an indicator of PMD (c-index = 0.780, P < 0.001). CONCLUSIONS Our study suggested that hs-CRP might be a useful biomarker for predicting the risk of PMD in patients with PAI.
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Affiliation(s)
- Pengyu Gong
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, China
| | - Yukai Liu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, China
| | - Ting Huang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, China
| | - Wenxiu Chen
- Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, No.68 Changle Road, Nanjing, 210006, Jiangsu, China
| | - Teng Jiang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, China
| | - Yachi Gong
- Department of Gerontology, Nantong Third Peoples Hospital, Nantong University, 60 Mid-Youth Road, Nantong, 226006, Jiangsu, China
| | - Min Lu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, China
| | - Meng Wang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, China
| | - Yingdong Zhang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, China.
| | - Xiaohao Zhang
- Department of Neurology, Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210002, Jiangsu, China
| | - Qiwen Deng
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, China.
| | - Junshan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, China.
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Eppinger S, Gattringer T, Nachbaur L, Fandler S, Pirpamer L, Ropele S, Wardlaw J, Enzinger C, Fazekas F. Are morphologic features of recent small subcortical infarcts related to specific etiologic aspects? Ther Adv Neurol Disord 2019; 12:1756286419835716. [PMID: 31040879 PMCID: PMC6477767 DOI: 10.1177/1756286419835716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 01/10/2019] [Indexed: 11/29/2022] Open
Abstract
Background: Recent small subcortical infarcts (RSSIs) mostly result from the occlusion of
a single, small, brain artery due to intrinsic cerebral small-vessel disease
(CSVD). Some RSSIs may be attributable to other causes such as cardiac
embolism or large-artery disease, and their association with coexisting CSVD
and vascular risk factors may vary with morphological magnetic resonance
imaging (MRI) features. Methods: We retrospectively identified all inpatients with a single symptomatic
MRI-confirmed RSSI between 2008 and 2013. RSSIs were rated for size, shape,
location (i.e. anterior: basal ganglia and centrum semiovale posterior
cerebral circulation: thalamus and pons) and MRI signs of concomitant CSVD.
In a further step, clinical data, including detailed diagnostic workup and
vascular risk factors, were analyzed with regard to RSSI features. Results: Among 335 RSSI patients (mean age 71.1 ± 12.1 years), 131 (39%) RSSIs were
>15 mm in axial diameter and 66 (20%) were tubular shaped. Atrial
fibrillation (AF) was present in 44 (13.1%) and an ipsilateral vessel
stenosis > 50% in 30 (9%) patients. Arterial hypertension and CSVD MRI
markers were more frequent in patients with anterior-circulation RSSIs,
whereas diabetes was more prevalent in posterior-circulation RSSIs. Larger
RSSIs occurred more frequently in the basal ganglia and pons, and the latter
were associated with signs of large-artery atherosclerosis. Patients with
concomitant AF had no specific MRI profile. Conclusion: Our findings suggest the contribution of different pathophysiological
mechanisms to the occurrence of RSSIs in the anterior and posterior cerebral
circulation. While there appears to be some general association of larger
infarcts in the pons with large-artery disease, we found no pattern
suggestive of AF in RSSIs.
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Affiliation(s)
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, A-8036 Graz, Austria
| | - Lena Nachbaur
- Department of Neurology, Medical University of Graz, Austria
| | - Simon Fandler
- Department of Neurology, Medical University of Graz, Austria
| | - Lukas Pirpamer
- Department of Neurology, Medical University of Graz, Austria
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Austria
| | - Joanna Wardlaw
- Brain Research Imaging Centre, The University of Edinburgh, Edinburgh, UK
| | | | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Austria
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Jiang J, Huang X, Zhang Y, Deng W, Shen F, Liu J. Total MRI burden of cerebral vessel disease correlates with the progression in patients with acute single small subcortical strokes. Brain Behav 2019; 9:e01173. [PMID: 30506998 PMCID: PMC6346414 DOI: 10.1002/brb3.1173] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/27/2018] [Accepted: 10/29/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The patients of single small subcortical strokes (SS) commonly have neurological worsening with risk factors, and mechanisms remain unclear. Asymptomatic lacunes, white matter lesions, cerebral microbleeds, and enlarged perivascular spaces are MRI markers of cerebral small vessel disease (cSVD). Previous studies mostly explored the association between the neurological deterioration and presence of above markers separately. The relationship between progressive single small SS and the simultaneous presence of multiple markers of cSVD has not been fully identified. We aimed to investigate whether total burden of cSVD detected with MRI was associated with progressive small SS in this study. METHODS Patients with single small SS (2.0 cm in diameter) were prospectively recruited during January 2016 and May 2018. Progression was defined as worsening by ≥1 point in National Institutes Health Stroke Scale (NIHSS) motor score within 72 hr from onset. The presence and burden of cSVD were determined by brain MRI, producing a score between 0 and 4. Besides, the patients' characteristics, clinical data, medical treatments during hospitalization stay were collected and statistically analyzed. Associations with progression were tested with forward stepwise regression analyses. RESULTS Fifty-seven (35.6%) patients underwent progression. No significant difference was observed in the distribution of any single vascular risk factor and its related laboratory data among these patients. After adjustment for age, sex, NIHSS score at admission, and time from stroke to MRI in separate models, severe WMHs (OR = 4.892; 95% CI = 2.011-11.904, p = 0.016), moderate- and high-grade basal ganglia EPVS (OR = 2.970; 95% CI = 1.861-6.121, p = 0.009), and total cSVD score (OR = 3.359; 95% CI = 2.016-5.599, p = 0.010) were associated with progression. CONCLUSION This study demonstrated that total MRI cSVD burden was independently associated with progression after single small subcortical strokes.
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Affiliation(s)
- Jingwen Jiang
- Department of Neurology, Ruijin Hospital North Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojun Huang
- Department of Neurology, Ruijin Hospital North Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Zhang
- Department of Neurology, Ruijin Hospital North Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiping Deng
- Department of Neurology, Ruijin Hospital North Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fanxia Shen
- Department of Neurology, Ruijin Hospital North Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianrong Liu
- Department of Neurology, Ruijin Hospital North Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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21
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Mantero V, Scaccabarozzi C, Botto E, Giussani G, Aliprandi A, Lunghi A, Ciusani E, Brenna G, Salmaggi A. Outcome in lacunar stroke: A cohort study. Acta Neurol Scand 2018; 138:320-326. [PMID: 29770431 DOI: 10.1111/ane.12961] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We evaluated a prospective cohort of 150 patients under observation in our centre for lacunar strokes. The purpose of this study was to evaluate the outcome at time of discharge and 6 months after lacunar stroke, as well as the correlation with cardiovascular risk factors and selected biochemical parameters already evaluated on admission. Focus was to identify possible prognostic factors, which might be targeted through appropriate intervention concentrating on reduction in the incidence and impact of early clinical deterioration. METHODS 150 patients with a lacunar stroke were included in the present study. A clinical 6-month follow-up was available for 98.7% of the patients. Infarcts were classified by size, shape and location. RESULTS The most important predictors of high NIHSS score at time of discharge resulted NIHSS on admission (P < .001), leukocytosis (P = .013), in-hospital infections (P = .016) and size of lacunae (P = .005). Similarly, the most important predictors of poor outcome 6 months later were NIHSS on admission (P = .01), leukocytosis (P = .014), elevated CRP (P = .019), in addition to pre-admission Rankin (P < .001). CONCLUSION Although infections are not causatively related to lacunar strokes, their prompt recognition and early treatment, control of inflammatory markers and fever are most important in influencing functional outcome in lacunar stroke.
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Affiliation(s)
- V. Mantero
- Neurology - Stroke Unit, “A. Manzoni” Hospital; ASST Lecco; Lecco Italy
| | - C. Scaccabarozzi
- Neurology - Stroke Unit, “A. Manzoni” Hospital; ASST Lecco; Lecco Italy
| | - E. Botto
- Neurology - Stroke Unit, “A. Manzoni” Hospital; ASST Lecco; Lecco Italy
| | - G. Giussani
- Neurology - Stroke Unit, “A. Manzoni” Hospital; ASST Lecco; Lecco Italy
| | - A. Aliprandi
- Neurology - Stroke Unit, “A. Manzoni” Hospital; ASST Lecco; Lecco Italy
| | - A. Lunghi
- Neuroradiological Unit; “A. Manzoni” Hospital; ASST Lecco; Lecco Italy
| | - E. Ciusani
- Laboratory of Clinical Pathology and Medical Genetics; Fondazione IRCCS Istituto Neurologico C. Besta; Milan Italy
| | - G. Brenna
- Department of Neuroimmunology and Neuromuscular Diseases; Fondazione IRCCS Istituto Neurologico C. Besta; Milan Italy
| | - A. Salmaggi
- Neurology - Stroke Unit, “A. Manzoni” Hospital; ASST Lecco; Lecco Italy
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22
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Oji S, Tomohisa D, Hara W, Tajima T, Suzuki M, Saito A, Yoshida N, Nomura K. Mean Platelet Volume Is Associated with Early Neurological Deterioration in Patients with Branch Atheromatous Disease: Involvement of Platelet Activation. J Stroke Cerebrovasc Dis 2018; 27:1624-1631. [PMID: 29428328 DOI: 10.1016/j.jstrokecerebrovasdis.2018.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 01/04/2018] [Accepted: 01/13/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The most attentive clinical problem in patients with branch atheromatous disease (BAD) is early neurological deterioration (END). Although the platelet activation (PA) is involved in pathogenesis, the relationship between PA and END has remained unclear. We investigated clinical data including mean platelet volume (MPV, fL) as a marker for PA to identify clinically useful biomarkers for END. METHODS A total of 64 patients with BAD were investigated retrospectively, and divided into 2 groups based on whether neurologic symptoms deteriorated or not: BAD with and without END (END and non-END). The END was defined as patients with point increase of 1 or greater in the National Institutes of Health Stroke Scale (NIHSS); non-END was defined as those without such increase. Clinical features such as NIHSS, modified Rankin scale (mRS), laboratory data including MPV, lesion size (LS, mm) on admission, and treatments were compared between the 2 groups. RESULTS Of 64 patients, 17 cases had an END. The median values of NIHSS, mRS, MPV, and LS on admission were significantly greater in END than in non-END (P < .05, respectively). There was no correlation of MPV with NIHSS, mRS and LS, respectively. The median values of MPV were significantly higher in END than in non-END and control (P < .05, respectively). A receiver operating characteristic curve indicated a value of 10.1 as cutoff level for MPV to discriminate between END and non-END. CONCLUSIONS High MPV values on admission may be an independent biomarker for END. Physicians should pay more careful attention to END in BAD showing MPV values higher than 10.1 on admission.
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Affiliation(s)
- Satoru Oji
- Saitama Medical Center, Saitama Medical University Kawagoe, Saitama, Japan.
| | - Dembo Tomohisa
- Saitama Medical Center, Saitama Medical University Kawagoe, Saitama, Japan
| | - Wataru Hara
- Saitama Medical Center, Saitama Medical University Kawagoe, Saitama, Japan
| | - Takashi Tajima
- Saitama Medical Center, Saitama Medical University Kawagoe, Saitama, Japan
| | - Masato Suzuki
- Saitama Medical Center, Saitama Medical University Kawagoe, Saitama, Japan
| | - Akane Saito
- Saitama Medical Center, Saitama Medical University Kawagoe, Saitama, Japan
| | - Norihito Yoshida
- Saitama Medical Center, Saitama Medical University Kawagoe, Saitama, Japan
| | - Kyoichi Nomura
- Saitama Medical Center, Saitama Medical University Kawagoe, Saitama, Japan
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Shinohara Y, Ogawa T. Reply. AJNR Am J Neuroradiol 2017; 38:E104. [PMID: 28818822 DOI: 10.3174/ajnr.a5364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Y Shinohara
- Division of Radiology Department of Pathophysiological and Therapeutic Science Faculty of Medicine Tottori University Yonago, Japan
| | - T Ogawa
- Division of Radiology Department of Pathophysiological and Therapeutic Science Faculty of Medicine Tottori University Yonago, Japan
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24
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Progressive deficit in isolated pontine infarction: the association with etiological subtype, lesion topography and outcome. Acta Neurol Belg 2017; 117:649-654. [PMID: 28776182 DOI: 10.1007/s13760-017-0827-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 07/26/2017] [Indexed: 10/19/2022]
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.
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Shinohara Y, Kato A, Kuya K, Okuda K, Sakamoto M, Kowa H, Ogawa T. Perfusion MR Imaging Using a 3D Pulsed Continuous Arterial Spin-Labeling Method for Acute Cerebral Infarction Classified as Branch Atheromatous Disease Involving the Lenticulostriate Artery Territory. AJNR Am J Neuroradiol 2017; 38:1550-1554. [PMID: 28596191 DOI: 10.3174/ajnr.a5247] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 03/27/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Branch atheromatous disease is a stroke subtype considered a risk factor for early neurologic deterioration. Meanwhile, crossed cerebellar diaschisis is thought to be influenced by the degree and location of supratentorial perfusion abnormalities and is associated with the clinical outcome in the case of an ischemic stroke. In this article, our aim was to clarify the utility of using a whole-brain 3D pulsed continuous arterial spin-labeling method as an imaging biomarker for predicting neurologic severity in branch atheromatous disease. MATERIALS AND METHODS Twenty-three patients with branch atheromatous disease in the lenticulostriate artery territory were enrolled. All patients underwent MR imaging, including DWI, 3D-TOF-MRA, and 3D-arterial spin-labeling. We measured the asymmetry index of CBF in the affected area (branch atheromatous disease), the asymmetry index of the contralateral cerebellar hemisphere (crossed cerebellar diaschisis), and the DWI infarct volume in the lenticulostriate artery territory. We also compared each parameter with the initial NIHSS score with the Pearson correlation coefficient. RESULTS Among the 23 patients, we found no correlation between NIHSS score and the asymmetry index of CBF in the affected area (branch atheromatous disease) (r = -0.027, P = .724), whereas the asymmetry index of the contralateral cerebellar hemisphere (crossed cerebellar diaschisis) and DWI infarct volumes were significantly correlated with NIHSS score (r = 0.515, P = .012; r = 0.664, P = .001, respectively). CONCLUSIONS In patients with branch atheromatous disease, 3D-arterial spin-labeling can detect crossed cerebellar diaschisis, which is correlated with the degree of neurologic severity.
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Affiliation(s)
- Y Shinohara
- From the Division of Radiology (Y.S., A.K., K.K., T.O.), Department of Pathophysiological and Therapeutic Science, Faculty of Medicine
| | - A Kato
- From the Division of Radiology (Y.S., A.K., K.K., T.O.), Department of Pathophysiological and Therapeutic Science, Faculty of Medicine
| | - K Kuya
- From the Division of Radiology (Y.S., A.K., K.K., T.O.), Department of Pathophysiological and Therapeutic Science, Faculty of Medicine
| | - K Okuda
- Division of Clinical Radiology (K.O.)
| | - M Sakamoto
- Division of Neurosurgery (M.S.), Department of Brain and Neurosciences, Faculty of Medicine
| | - H Kowa
- Division of Neurology (H.K.), Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - T Ogawa
- From the Division of Radiology (Y.S., A.K., K.K., T.O.), Department of Pathophysiological and Therapeutic Science, Faculty of Medicine
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The role of phenylephrine in patients with small deep subcortical infarct and progressive weakness. J Neurol Sci 2017; 377:107-111. [DOI: 10.1016/j.jns.2017.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 03/10/2017] [Accepted: 04/06/2017] [Indexed: 11/17/2022]
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27
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Takeuchi M, Miyashita K, Nakagawara J, Toyoda K, Todo K, Metoki N, Suzuki R, Manabe Y, Akaiwa Y, Yamamoto Y, Nagatsuka K. Analysis of Factors Associated with Progression and Long-Term Outcomes of Penetrating Artery Territory Infarction: A Retrospective Study. J Stroke Cerebrovasc Dis 2016; 25:1952-9. [PMID: 27199201 DOI: 10.1016/j.jstrokecerebrovasdis.2016.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 04/05/2016] [Accepted: 04/14/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Patients with penetrating artery territory infarction occasionally show progressive motor deficits during the acute stage with poor prognosis. Predictive indices or medical therapies for suppressing the symptomatic progression (SP) of penetrating artery infarction have not been established. In this study, we investigated SP-related clinical factors and functional outcomes, specifically improvement 3 months post ictus in patients with penetrating artery infarction. METHODS We retrospectively examined acute stroke patients with penetrating artery infarction admitted at 7 collaborative hospitals. SP was defined as an increase by 1 point or higher in the National Institutes of Health Stroke Scale score. Functional improvement was assessed based on the modified Rankin Scale at 3 months. The influence of factors, such as patient characteristics, clinical data, medical treatment during the acute stage and on SP, and functional improvement was statistically analyzed. RESULTS Four hundred eighty-eight patients (310 men; mean age, 70 years) were examined. Sixty-eight patients (14%) exhibited SP. Multivariate logistic regression analysis revealed that higher hemoglobin A1c (odds ratio [OR], 1.30; 95% confidence interval [CI], 1.10-1.55), body mass index (BMI; OR, .85; 95% CI, .77-.94), and systolic blood pressure on admission (OR, 1.63; 95% CI, 1.19-2.25) were independent predictors of SP in penetrating artery infarction. Dual antiplatelet therapy (DAPT; OR, 3.48; 95% CI, 1.52-8.38) independently influenced functional improvement. CONCLUSIONS Initial high blood pressure, diabetes, and low BMI on admission were associated with early progression of penetrating artery infarction. DAPT during the acute stage may contribute to functional improvement.
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Affiliation(s)
- Mariko Takeuchi
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Kotaro Miyashita
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Jyoji Nakagawara
- Department of Neurosurgery and Stroke Center, Nakamura Memorial Hospital, Sapporo, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenichi Todo
- Department of Neurology, Stroke Center, Kobe City General Hospital, Kobe, Japan
| | | | - Rieko Suzuki
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yasuhiro Manabe
- Department of Neurology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Yasuhisa Akaiwa
- Department of Neurology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yasumasa Yamamoto
- Department of Neurology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Kazuyuki Nagatsuka
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
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Lv P, Jin H, Liu Y, Cui W, Peng Q, Liu R, Sun W, Fan C, Teng Y, Sun W, Huang Y. Comparison of Risk Factor between Lacunar Stroke and Large Artery Atherosclerosis Stroke: A Cross-Sectional Study in China. PLoS One 2016; 11:e0149605. [PMID: 26934734 PMCID: PMC4774914 DOI: 10.1371/journal.pone.0149605] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 02/03/2016] [Indexed: 12/01/2022] Open
Abstract
Background Stroke is the second most common cause of mortality in China. Although most subtypes of ischemic stroke share similar risk factors, they have different etiologies. Our study aimed to evaluate the different risk factor profiles between the stroke subtypes, lacunar infarcts (LI) and large-artery atherosclerosis (LAA), and clarify the characteristics of current acute ischemic stroke in China. Methods In this cross-sectional study, we analyzed the clinical characteristics of 1982 patients with acute ischemic stroke who were admitted to the neurology department at the Peking University First Hospital between 2007 and 2014. Ischemic stroke was further classified into LAA, LI, cardioembolism (CE) and undetermined causes of infarction (UDI) according to TOAST classification. Demographic characteristics, risk factors, as well as the findings of laboratory and imaging tests of 1773 patients with LAA and LI, were analyzed by univariate and multivariate logistic analysis. Results Of the 1982 ischemic stroke patients included in this study, 1207 were diagnosed with LAA, 566 with LI, 173 with cardioembolism (CE) and 36 with undetermined causes of infarction (UDI). By comparing the risk factors in multivariate logistic regression analysis, hypertension [odds ratio (OR) = 1.832] and white matter leukoaraiosis (WML) (OR = 1.865) were found to be more strongly correlated with LI than LAA. Low density lipoprotein- cholesterol (LDL-c) (OR = 0.774) were more strongly related to LAA than LI. Conclusions This study found that hypertension and WML were more strongly correlated with LI than LAA. LDL-c was more strongly related to LAA than LI.
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Affiliation(s)
- Pu Lv
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Haiqiang Jin
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yuanyuan Liu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Wei Cui
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Qing Peng
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Ran Liu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Wei Sun
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Chenghe Fan
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yuming Teng
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Weiping Sun
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yining Huang
- Department of Neurology, Peking University First Hospital, Beijing, China
- * E-mail:
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29
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Yang L, Qin W, Zhang X, Li Y, Gu H, Hu W. Infarct Size May Distinguish the Pathogenesis of Lacunar Infarction of the Middle Cerebral Artery Territory. Med Sci Monit 2016; 22:211-8. [PMID: 26788612 PMCID: PMC4727492 DOI: 10.12659/msm.896898] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Lacunar infarctions are caused by small vessel disease (SVD) and branch atheromatous disease (BAD). Lacunar infarction may be classified as proximal vessel lacunar infarction (BAD) or distal vessel lacunar infarction (SVD) according to its location within the middle cerebral artery (MCA) territory in patients with normal MCA. Studies found that the lenticulostriate arteries may exist different ways and that the size of lacunar infarction may be dependent on the branching order. We investigated whether lacunar infarction size can differentiate between SVD and BAD in patients with normal MCA. Material/Methods We retrospectively studied 312 patients with lacunar infarction who had normal MCA on MR angiography. We found the normal flow void of the MCA on MR T2-weighted images, and the same layer on DWI was considered the level 0. The median of lowest layer of infarction lesions and the mean of lesion size were considered the cutoff point. We divided lacunar infarction into 2 groups according to cutoff point of lesion location and size. Data compared between the 2 groups included clinical information, radiography, and National Institutes of Health Stroke Scale score. Results Of all the 312 patients, the median of lowest layer of infarction lesions was the 3rd level. Compared to patients with BAD, according to infarct location, patients with SVD were older, more often had a history of hypertension and smoking, and had more severe leukoaraiosis and smaller infarct lesions. The mean length of lesions was 11.1 mm on DWI images. Patients with SVD, according to infarct size, had lower NIHSS scores at admission. The mean lesion height was 12.26 mm on FLAIR images. Patients with SVD were more often male, had higher prevalence of smoking, and had more severe leukoaraiosis and lower NIHSS scores at admission. The lacunar infarction diameter on DWI and FLAIR images was negatively correlated with the level of lowest layer of infarction lesions. Conclusions Our data suggest that infarct lesion size may be used as a method to distinguish SVD and BAD in lacunar infarction patients with normal MCA.
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Affiliation(s)
- Lei Yang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Wei Qin
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Xiaoyu Zhang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Yue Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Hua Gu
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
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Nannoni S, Del Bene A, Palumbo V, Petrone L, Sottile F, Pracucci G, Inzitari D. Predictors of progression in patients presenting with minor subcortical stroke. Acta Neurol Scand 2015; 132:304-9. [PMID: 25809191 DOI: 10.1111/ane.12399] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Early neurological worsening is common in minor subcortical strokes (SS) and may lead to a poor outcome. We aimed to describe clinical and imaging features associated with progression. MATERIAL AND METHODS Consecutive patients with SS were divided into progressive and non-progressive. Progression was defined as an increase of NIHSS motor score ≥ 1 point within 72 h from onset. Vascular risk factors and imaging features (vascular territory, size and number of slices in which the lesion was visible, the presence of leukoaraiosis) were compared in the two groups. We investigated potential independent determinants of progression using stepwise logistic regression. RESULTS Thirty of 94 patients (31.9%) underwent progression. The distribution of vascular risk factors did not differ significantly between the two groups. Increasing number of risk factors was associated with a higher risk of progression (OR 2.2; 95% CI 1.1-4.5). Patients who progressed were more likely to have a lesion ≥ 15 mm in diameter (P = 0.004) or a lesion visible ≥ 3 slices (P = 0.007). After logistic regression stepwise adjustment for all the considered potential determinants, diameter ≥ 15 mm and severe leukoaraiosis proved to be independently associated with neurological worsening (OR = 6.3, 95% CI 2.0-19.6 and OR = 5.9, 95% CI 1.3-25.7, respectively). CONCLUSION In a series of consecutive SS, early neurological worsening was associated with a high vascular risk profile, a larger infarct size and the presence of severe leukoaraiosis. Based on the knowledge that extensive microvascular changes are a feature of severe leukoaraiosis, we hypothesize that stroke progression could be promoted through an impaired compensatory flow in the penumbral area.
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Affiliation(s)
- S. Nannoni
- NEUROFARBA Department; Neuroscience Section; University of Florence; Florence Italy
| | - A. Del Bene
- NEUROFARBA Department; Neuroscience Section; University of Florence; Florence Italy
| | - V. Palumbo
- Stroke Unit and Neurology; Careggi University Hospital; Florence Italy
| | - L. Petrone
- NEUROFARBA Department; Neuroscience Section; University of Florence; Florence Italy
| | - F. Sottile
- Department of Clinical and Experimental Medicine; University of Messina; Messina Italy
| | - G. Pracucci
- NEUROFARBA Department; Neuroscience Section; University of Florence; Florence Italy
| | - D. Inzitari
- NEUROFARBA Department; Neuroscience Section; University of Florence; Florence Italy
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Huang R, Zhang X, Chen W, Lin J, Chai Z, Yi X. Stroke Subtypes and Topographic Locations Associated with Neurological Deterioration in Acute Isolated Pontine Infarction. J Stroke Cerebrovasc Dis 2015; 25:206-13. [PMID: 26508683 DOI: 10.1016/j.jstrokecerebrovasdis.2015.09.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/11/2015] [Accepted: 09/19/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE This study investigated predictors of neurological deterioration (ND) in acute isolated pontine infarction. METHODS Two hundred fifty-nine patients with acute isolated pontine infarctions identified using diffusion-weighted imaging were retrospectively analyzed. The patients were divided according to the presence/absence of ND, defined as increased (≥2 units) National Institutes of Health Stroke Scale scores 5 days after onset. Pontine infarctions comprised 3 stroke subtypes: vertebrobasilar large-artery disease, basilar artery branch disease (BABD), and small-artery disease (SAD), according to basilar artery atherosclerosis severity and lesion extent of the transverse axial plane. Topographic locations of longitudinal pontine infarctions in the axial plane were divided into upper, middle, lower, and whole. RESULTS Of the 259 patients (male : female = 136:123, 68.84 ± 10.24), only 27.4% exhibited ND. The prevalence was significantly increased in females, whereas smoking was significantly decreased in patients with ND. BABD and lower pontine infarctions were significantly more frequent in patients with ND (70.4% and 43.7%, respectively) than in patients without ND (51.6% and 30.3%, respectively). SAD and upper pontine infarctions were significantly less frequent in patients with ND (16.9% and 7.0%, respectively) than in patients without ND (30.3% and 23.4%, respectively). BABD and lower pontine infarctions were positively related to ND. CONCLUSIONS This is the first study to demonstrate that BABD and lower pons lesions are predictors of ND in acute isolated pontine infarction. These findings indicate the potential importance of early identification of stroke subtypes and topographic locations in the prevention of ND in patients with suspected pontine infarction.
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Affiliation(s)
- Ruyue Huang
- Department of Neurology, Third Affiliated Hospital of Wenzhou Medical University, Ruian, Zhejiang Province, China
| | - Xia Zhang
- Department of Neurology, Third Affiliated Hospital of Wenzhou Medical University, Ruian, Zhejiang Province, China
| | - Weili Chen
- Department of Neurology, Third Affiliated Hospital of Wenzhou Medical University, Ruian, Zhejiang Province, China
| | - Jing Lin
- Department of Neurology, Third Affiliated Hospital of Wenzhou Medical University, Ruian, Zhejiang Province, China
| | - Zhenxiao Chai
- Department of Neurology, Third Affiliated Hospital of Wenzhou Medical University, Ruian, Zhejiang Province, China
| | - Xingyang Yi
- Department of Neurology, People's Hospital of Deyang City, Deyang, Sichuan Province, China.
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Kim JP, Kim SJ, Lee JJ, Cha JH, Bang OY, Chung CS, Lee KH, Kim GM. Diffusion-Perfusion Mismatch in Single Subcortical Infarction: A Predictor of Early Neurological Deterioration and Poor Functional Outcome. Eur Neurol 2015; 73:353-9. [DOI: 10.1159/000430461] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 04/12/2015] [Indexed: 11/19/2022]
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Li JB, Cheng RD, Zhou L, Wen WS, Zhu GY, Tian L, Ye XM. What drives progressive motor deficits in patients with acute pontine infarction? Neural Regen Res 2015; 10:501-4. [PMID: 25878603 PMCID: PMC4396117 DOI: 10.4103/1673-5374.153703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 11/16/2022] Open
Abstract
Progressive motor deficits are relatively common in acute pontine infarction and frequently associated with increased functional disability. However, the factors that affect the progression of clinical motor weakness are largely unknown. Previous studies have suggested that pontine infarctions are caused mainly by basilar artery stenosis and penetrating artery disease. Recently, lower pons lesions in patients with acute pontine infarctions have been reported to be related to progressive motor deficits, and ensuing that damage to the corticospinal tracts may be responsible for the worsening of neurological symptoms. Here, we review studies on motor weakness progression in pontine infarction and discuss the mechanisms that may underlie the neurologic worsening.
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Affiliation(s)
- Jue-Bao Li
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
| | - Rui-Dong Cheng
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
| | - Liang Zhou
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
| | - Wan-Shun Wen
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
| | - Gen-Ying Zhu
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
| | - Liang Tian
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
| | - Xiang-Ming Ye
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
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Abstract
Small deep brain infarcts are often caused by two different vascular pathologies: 1. atheromatous occlusion at the orifice of large caliber penetrating arteries termed branch atheromatous disease (BAD) and 2. lipohyallinotic degenerative changes within the course of penetrating arteries termed lipohyalinitic degeneration. Representative vascular territories of BAD type infarcts are lenticulostriate artery (LSA), pontine paremedian artery (PPA) and less frequently anterior choroidal artery. BAD type infarcts are strongly associated with progressive motor deficits (PMD) leading to a worse functional outcome, because they affect pyramidal tract at corona radiata, pontine base or internal capsule. In our study, female sex and initial severity of motor deficits were common predictors for PMD in both groups with LSA and PPA. Single infarcts without concomitant silent lacunar infarcts and preceding lacunar transient ischemic attack (TIA) in the LSA group, and diabetes mellitus in the PPA group were independent predictors for PMD in penetrating artery infarctions. There were different characteristics between the groups of LSA and PPA. Prevalence of male gender, diabetes mellitus and intracranial atherosclerosis were significantly higher in the PPA group than in the LSA group. The combined treatment of cilostazol and edarabone significantly improved functional outcome especially in the PPA infarct group. Adjoining clopidgrel on aforementioned combined treatment further improved functional outcome in the LSA group. The actions of vasodilatation and endothelial protection in cilostazol and inhibition of shear-induced platelet activation in clopidogrel, as well as scavenging free radicals in edaravone might work effectively.
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Nakase T, Sasaki M, Ikeda Y, Suzuki A. Progressing small vessel pontine infarction includes different etiologies. Ann Clin Transl Neurol 2014; 1:75-9. [PMID: 25356386 PMCID: PMC4212484 DOI: 10.1002/acn3.25] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 10/25/2013] [Accepted: 12/01/2013] [Indexed: 11/07/2022] Open
Abstract
Background The aim of this study was to investigate the clinical features of progressing stroke of pontine infarction as small vessel disease. Methods Enrolled 38 acute pontine infarctions were confirmed by magnetic resonance imaging and magnetic resonance angiography at the first and seventh days. Ten patients (26.3%) presented progression (NIH Stroke Scale ≥2 increase within 72 h). Results Progressing patients showed no relation to the size and the distribution of lesion. Expansion of ischemic lesion showed correlation with basilar artery atherosclerosis. Stable lesion related to delayed worsening. Conclusion These findings suggest that progressing stroke may be caused by not only the worsening of blood flow of ischemic lesion but also delayed neuronal death.
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Affiliation(s)
- Taizen Nakase
- Department of Stroke Science, Research Institute for Brain and Blood Vessels Akita, Japan
| | - Masahiro Sasaki
- Department of Stroke Science, Research Institute for Brain and Blood Vessels Akita, Japan
| | - Yasuko Ikeda
- Department of Stroke Science, Research Institute for Brain and Blood Vessels Akita, Japan
| | - Akifumi Suzuki
- Department of Stroke Science, Research Institute for Brain and Blood Vessels Akita, Japan
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Asdaghi N, Pearce LA, Nakajima M, Field TS, Bazan C, Cermeno F, McClure LA, Anderson DC, Hart RG, Benavente OR. Clinical correlates of infarct shape and volume in lacunar strokes: the Secondary Prevention of Small Subcortical Strokes trial. Stroke 2014; 45:2952-8. [PMID: 25190442 DOI: 10.1161/strokeaha.114.005211] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND PURPOSE Infarct size and location are thought to correlate with different mechanisms of lacunar infarcts. We examined the relationship between the size and shape of lacunar infarcts and vascular risk factors and outcomes. METHODS We studied 1679 participants in the Secondary Prevention of Small Subcortical Stroke trial with a lacunar infarct visualized on diffusion-weighted imaging. Infarct volume was measured planimetrically, and shape was classified based on visual analysis after 3-dimensional reconstruction of axial MRI slices. RESULTS Infarct shape was ovoid/spheroid in 63%, slab in 12%, stick in 7%, and multicomponent in 17%. Median infarct volume was smallest in ovoid/spheroid relative to other shapes: 0.46, 0.65, 0.54, and 0.90 mL, respectively (P<0.001). Distributions of vascular risk factors were similar across the 4 groups except that patients in the ovoid/spheroid and stick groups were more often diabetic and those with multicomponent had significantly higher blood pressure at study entry. Intracranial stenosis did not differ among groups (P=0.2). Infarct volume was not associated with vascular risk factors. Increased volume was associated with worse functional status at baseline and 3 months. Overall, 162 recurrent strokes occurred during an average of 3.4 years of follow-up with no difference in recurrent ischemic stroke rate by shape or volume. CONCLUSIONS In patients with recent lacunar stroke, vascular risk factor profile was similar among the different infarct shapes and sizes. Infarct size correlated with worse short-term functional outcome. Neither shape nor volume was predictive of stroke recurrence. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00059306.
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Affiliation(s)
- Negar Asdaghi
- From the Division of Neurology, Department of Medicine, Brain Research Centre, University of British Columbia, Vancouver, British Columbia, Canada (N.A., M.N., T.S.F., F.C., O.R.B.); Biostatistics Consultant, Minot, ND (L.A.P.); Department of Radiology, University of Texas Health Sciences Centre, San Antonio (C.B.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Department of Neurology, Hennepin County Medical Center and the University of Minnesota, Minneapolis (D.C.A.); Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontatio, Canada (R.G.H.); SPS3 Coordinating Center (N.A., L.A.P., M.N., T.S.F., C.B., F.C., R.G.H., O.R.B.); and SPS3 Statistical Center (L.A.M.)
| | - Lesly A Pearce
- From the Division of Neurology, Department of Medicine, Brain Research Centre, University of British Columbia, Vancouver, British Columbia, Canada (N.A., M.N., T.S.F., F.C., O.R.B.); Biostatistics Consultant, Minot, ND (L.A.P.); Department of Radiology, University of Texas Health Sciences Centre, San Antonio (C.B.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Department of Neurology, Hennepin County Medical Center and the University of Minnesota, Minneapolis (D.C.A.); Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontatio, Canada (R.G.H.); SPS3 Coordinating Center (N.A., L.A.P., M.N., T.S.F., C.B., F.C., R.G.H., O.R.B.); and SPS3 Statistical Center (L.A.M.)
| | - Makoto Nakajima
- From the Division of Neurology, Department of Medicine, Brain Research Centre, University of British Columbia, Vancouver, British Columbia, Canada (N.A., M.N., T.S.F., F.C., O.R.B.); Biostatistics Consultant, Minot, ND (L.A.P.); Department of Radiology, University of Texas Health Sciences Centre, San Antonio (C.B.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Department of Neurology, Hennepin County Medical Center and the University of Minnesota, Minneapolis (D.C.A.); Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontatio, Canada (R.G.H.); SPS3 Coordinating Center (N.A., L.A.P., M.N., T.S.F., C.B., F.C., R.G.H., O.R.B.); and SPS3 Statistical Center (L.A.M.)
| | - Thalia S Field
- From the Division of Neurology, Department of Medicine, Brain Research Centre, University of British Columbia, Vancouver, British Columbia, Canada (N.A., M.N., T.S.F., F.C., O.R.B.); Biostatistics Consultant, Minot, ND (L.A.P.); Department of Radiology, University of Texas Health Sciences Centre, San Antonio (C.B.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Department of Neurology, Hennepin County Medical Center and the University of Minnesota, Minneapolis (D.C.A.); Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontatio, Canada (R.G.H.); SPS3 Coordinating Center (N.A., L.A.P., M.N., T.S.F., C.B., F.C., R.G.H., O.R.B.); and SPS3 Statistical Center (L.A.M.)
| | - Carlos Bazan
- From the Division of Neurology, Department of Medicine, Brain Research Centre, University of British Columbia, Vancouver, British Columbia, Canada (N.A., M.N., T.S.F., F.C., O.R.B.); Biostatistics Consultant, Minot, ND (L.A.P.); Department of Radiology, University of Texas Health Sciences Centre, San Antonio (C.B.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Department of Neurology, Hennepin County Medical Center and the University of Minnesota, Minneapolis (D.C.A.); Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontatio, Canada (R.G.H.); SPS3 Coordinating Center (N.A., L.A.P., M.N., T.S.F., C.B., F.C., R.G.H., O.R.B.); and SPS3 Statistical Center (L.A.M.)
| | - Franco Cermeno
- From the Division of Neurology, Department of Medicine, Brain Research Centre, University of British Columbia, Vancouver, British Columbia, Canada (N.A., M.N., T.S.F., F.C., O.R.B.); Biostatistics Consultant, Minot, ND (L.A.P.); Department of Radiology, University of Texas Health Sciences Centre, San Antonio (C.B.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Department of Neurology, Hennepin County Medical Center and the University of Minnesota, Minneapolis (D.C.A.); Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontatio, Canada (R.G.H.); SPS3 Coordinating Center (N.A., L.A.P., M.N., T.S.F., C.B., F.C., R.G.H., O.R.B.); and SPS3 Statistical Center (L.A.M.)
| | - Leslie A McClure
- From the Division of Neurology, Department of Medicine, Brain Research Centre, University of British Columbia, Vancouver, British Columbia, Canada (N.A., M.N., T.S.F., F.C., O.R.B.); Biostatistics Consultant, Minot, ND (L.A.P.); Department of Radiology, University of Texas Health Sciences Centre, San Antonio (C.B.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Department of Neurology, Hennepin County Medical Center and the University of Minnesota, Minneapolis (D.C.A.); Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontatio, Canada (R.G.H.); SPS3 Coordinating Center (N.A., L.A.P., M.N., T.S.F., C.B., F.C., R.G.H., O.R.B.); and SPS3 Statistical Center (L.A.M.)
| | - David C Anderson
- From the Division of Neurology, Department of Medicine, Brain Research Centre, University of British Columbia, Vancouver, British Columbia, Canada (N.A., M.N., T.S.F., F.C., O.R.B.); Biostatistics Consultant, Minot, ND (L.A.P.); Department of Radiology, University of Texas Health Sciences Centre, San Antonio (C.B.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Department of Neurology, Hennepin County Medical Center and the University of Minnesota, Minneapolis (D.C.A.); Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontatio, Canada (R.G.H.); SPS3 Coordinating Center (N.A., L.A.P., M.N., T.S.F., C.B., F.C., R.G.H., O.R.B.); and SPS3 Statistical Center (L.A.M.)
| | - Robert G Hart
- From the Division of Neurology, Department of Medicine, Brain Research Centre, University of British Columbia, Vancouver, British Columbia, Canada (N.A., M.N., T.S.F., F.C., O.R.B.); Biostatistics Consultant, Minot, ND (L.A.P.); Department of Radiology, University of Texas Health Sciences Centre, San Antonio (C.B.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Department of Neurology, Hennepin County Medical Center and the University of Minnesota, Minneapolis (D.C.A.); Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontatio, Canada (R.G.H.); SPS3 Coordinating Center (N.A., L.A.P., M.N., T.S.F., C.B., F.C., R.G.H., O.R.B.); and SPS3 Statistical Center (L.A.M.)
| | - Oscar R Benavente
- From the Division of Neurology, Department of Medicine, Brain Research Centre, University of British Columbia, Vancouver, British Columbia, Canada (N.A., M.N., T.S.F., F.C., O.R.B.); Biostatistics Consultant, Minot, ND (L.A.P.); Department of Radiology, University of Texas Health Sciences Centre, San Antonio (C.B.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Department of Neurology, Hennepin County Medical Center and the University of Minnesota, Minneapolis (D.C.A.); Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontatio, Canada (R.G.H.); SPS3 Coordinating Center (N.A., L.A.P., M.N., T.S.F., C.B., F.C., R.G.H., O.R.B.); and SPS3 Statistical Center (L.A.M.).
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Duan Z, Sun W, Liu W, Xiao L, Huang Z, Cao L, Li H, Xiong Y, Liu D, Xu G, Liu X. Acute Diffusion-Weighted Imaging Lesion Patterns Predict Progressive Small Subcortical Infarct in the Perforator Territory of the Middle Cerebral Artery. Int J Stroke 2014; 10:207-12. [PMID: 25185717 DOI: 10.1111/ijs.12352] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 05/07/2014] [Indexed: 11/29/2022]
Abstract
Background Single small subcortical infarct (SSSI) is generally considered to have a fair outcome. However, early neurological deterioration (END), a relatively unfavorable clinical course occurring during the acute phase of infarction, is not uncommon. Aims The aim of this study was to investigate the relationship between lesion patterns detected by diffusion-weighted imaging (DWI) and the presence of END in patients with acute SSSI in the perforator territory of the middle cerebral artery (MCA). Methods Three hundred twelve patients with acute SSSI in the perforator territory of MCA were prospectively recruited from Jinling Hospital between January 2010 and May 2013. Acute DWI lesion patterns were classified as proximal SSSI (pSSSI) or distal SSSI (dSSSI) patterns, according to the relationship between lesion location and the parent artery. Neurological deficits were evaluated using the National Institutes of Health Stroke Scale (NIHSS) at admission and continued over the following 72 h 1–3 times a day. END was defined as an increase in NIHSS score ⩾2 points during the first 72 h after admission. Results Of the total 312 patients, the pSSSI pattern was found in 139 (44·55%) patients and the dSSSI pattern in 173 (55·45%) patients. Statistical analysis suggested that the indicators for small-artery disease (hypertension and leukoaraiosis) and atherosclerosis (diabetes mellitus and cerebral atherosclerosis) significantly differed according to lesion patterns ( P < 0·05). During hospitalization, 88 (28·21%) patients experienced END. Univariate analysis revealed that female sex ( P = 0·004), pSSSI pattern ( P < 0·001), initial NIHSS ( P = 0·001), lesion diameter ( P = 0·005), ipsilateral large-artery stenosis ( P = 0·008), and concomitant intracranial atherosclerotic stenosis ( P = 0·021) were significantly associated with END. After adjusting for confounding factors, pSSSI pattern was an independent predictor of END (OR 1·871, 95% CI 1·095–3·198, P = 0·022). In the further subgroup analysis of patients with different etiologies, pSSSI pattern was found to be independently associated with END in patients with large-artery atherosclerosis (OR 3·593, 95% CI 1·268–11·057, P = 0·026) and in patients with small-artery disease (OR 2·523, 95% CI 1·121–5·676, P = 0·025), but not in patients with cardioembolism (OR 0·854, 95% CI 0·147–4·953, P = 0·861). Conclusions pSSSI pattern was closely related to END in acute SSSI caused by large-artery atherosclerosis and small-artery disease in the perforator territory of the MCA.
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Affiliation(s)
- Zuowei Duan
- Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China
| | - Wen Sun
- Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China
| | - Wenhua Liu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Lulu Xiao
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Zhixin Huang
- Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China
| | - Liping Cao
- Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China
| | - Hua Li
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Yunyun Xiong
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Dezhi Liu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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Nakase T, Sasaki M, Suzuki A. The Effect of Acute Medication with Cilostazol, an Anti-platelet Drug, on the Outcome of Small Vessel Brain Infarction. J Stroke Cerebrovasc Dis 2014; 23:1409-15. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.11.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 11/20/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022] Open
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Del Bene A, Makin SDJ, Doubal FN, Inzitari D, Wardlaw JM. Variation in risk factors for recent small subcortical infarcts with infarct size, shape, and location. Stroke 2013; 44:3000-6. [PMID: 24008573 DOI: 10.1161/strokeaha.113.002227] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Lacunar infarction is attributable to a perforating arteriolar abnormality. Possible causes include embolism, atheromatosis, or intrinsic disease. We examined whether the size, shape, or location of the lacunar infarct varied with embolic sources, systemic atheroma, or vascular risk factors. METHODS We examined data from 3 prospective studies of patients with clinical and diffusion-weighted imaging-positive symptomatic lacunar infarction who underwent full clinical assessment and investigation for stroke risk factors. Lacunar infarct sizes (maximum diameter; shape, oval/tubular; location, basal ganglia/centrum semiovale/brain stem) were coded blind to clinical details. RESULTS Among 195 patients, 48 infarcts were tubular, 50 were 15 to 20 mm in diameter, and 97 and 74 were located in the basal ganglia and the centrum semiovale, respectively. There was no association between infarct size or shape and any of the risk factors. Centrum semiovale infarcts were less likely to have a potential relevant embolic source (4% versus 11%; odds ratio, 0.16; 95% confidence interval, 0.03-0.83) and caused a lower National Institute of Health Stroke Scale score (2 versus 3; odds ratio, 0.78; 95% confidence interval, 0.62-0.98) than basal ganglia infarcts. There were no other differences by infarct location. CONCLUSIONS Lacunar infarcts in the basal ganglia caused marginally severer strokes and were 3 times more likely to have a potential embolic source than those in the centrum semiovale, but the overall rate of carotid or known cardiac embolic sources (11%) was low. We found no evidence that other risk factors differed with location, size, or shape, suggesting that most lacunar infarcts share a common intrinsic arteriolar pathology.
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Affiliation(s)
- Alessandra Del Bene
- From the NEUROFARBA Department, Neuroscience Section, University of Florence, Italy (A.D.B., D.I.); and Divisions of Neuroimaging Sciences (S.D.J.M., J.M.W.) and Geriatric Medicine (F.N.D.), Western General Hospital, University of Edinburgh, Edinburgh, UK
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Senda J, Ito K, Ohyama K, Yoneyama N, Hara K, Nakamura R, Noda T, Hashizume A, Atsuta N, Ito M, Watanabe H, Yasui K, Kotake T, Kida Y, Kishimoto H, Sobue G. Investigation of inpatient convalescent rehabilitation outcomes in branch atheromatous disease (BAD). ACTA ACUST UNITED AC 2013. [DOI: 10.3995/jstroke.35.441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sakamoto Y, Kimura K, Aoki J, Shibazaki K. The augmentation index as a useful indicator for predicting early symptom progression in patients with acute lacunar and atherothrombotic strokes. J Neurol Sci 2012; 321:54-7. [DOI: 10.1016/j.jns.2012.07.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Revised: 06/08/2012] [Accepted: 07/20/2012] [Indexed: 10/28/2022]
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Del Bene A, Palumbo V, Lamassa M, Saia V, Piccardi B, Inzitari D. Progressive lacunar stroke: review of mechanisms, prognostic features, and putative treatments. Int J Stroke 2012; 7:321-9. [PMID: 22463492 DOI: 10.1111/j.1747-4949.2012.00789.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Lacunar stroke is generally considered to have a fair outcome. However 20-30% of patients with lacunar stroke worsen neurologically in hours or days after onset, reaching eventually an unexpectedly severe disability status. In the field of acute stroke, progressive lacunar stroke remains an important unresolved practice problem, because as yet no treatment does exist proven to prevent or halt progression. Pathophysiology of progression is yet incompletely understood. Hemodynamic factors, extension of thrombosis, excitotoxicity, and inflammation, have been proposed as possible mechanisms of progression. A few clinical studies also aimed at establishing presentation features that may help identifying patients at risk of deterioration. In this paper, we review hypothesized mechanisms of lacunar stroke progression and possible markers of early deterioration. Moreover, based on putative mechanisms and suggestions from reported evidence, we propose a few treatments that seem worthy to be tested by randomized clinical trials.
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Affiliation(s)
- Alessandra Del Bene
- Department of Neurological and Psychiatric Sciences, University of Florence, Viale Morgagni, 85, 50134 Florence, Italy.
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Nakamura T, Tsuruta S, Uchiyama S. Cilostazol combined with aspirin prevents early neurological deterioration in patients with acute ischemic stroke: A pilot study. J Neurol Sci 2012; 313:22-6. [DOI: 10.1016/j.jns.2011.09.038] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Revised: 09/24/2011] [Accepted: 09/28/2011] [Indexed: 10/16/2022]
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Yamamoto Y, Ohara T, Ishii R, Tanaka E, Murai T, Morii F, Tamura A, Oohara R. A Combined Treatment for Acute Larger Lacunar-Type Infarction. J Stroke Cerebrovasc Dis 2011; 20:387-94. [DOI: 10.1016/j.jstrokecerebrovasdis.2010.02.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 02/10/2010] [Accepted: 02/13/2010] [Indexed: 10/19/2022] Open
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Ohara T, Yamamoto Y, Nagakane Y, Tanaka E, Morii F, Koizumi T. [Classification of etiologic subtypes for transient ischemic attacks: clinical significance of lacunar transient ischemic attack]. Rinsho Shinkeigaku 2011; 51:406-411. [PMID: 21735732 DOI: 10.5692/clinicalneurol.51.406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Lacunar transient ischemic attack (lacunar TIA) may have been underestimated because of diagnostic difficulties. The aim of our study was to classify TIAs by etiologic subtypes, especially using defined criteria for diagnosis of lacunar TIA and clarify clinical characteristics of lacunar TIA. METHOD 105 TIA patients out of consecutive 1,244 patients with acute ischemic stroke admitted to our hospital between January 2007 and June 2010 were enrolled in the present study. TIA was defined as an acute focal neurological deficit lasting less than 24 hours, suspected to be of cerebrovascular origin regardless of ischemic lesions on MRI. TIAs were classified to 5 etiologic subtypes; (1) cardioembolic TIA, (2) atherothrombotic TIA, (3) lacunar TIA, (4) other etiologies, and (5) undetermined etiology and clinical characteristics in each subtype and the incidence of recurrent stroke after TIA were investigated. Lacunar TIA was diagnosed if the following criteria were fulfilled; (1) presence of lacunar infarct on MRI and/or the presence of unilateral dysfunction of at least two of three body parts (face, arm, leg) in the absence of cortical dysfunction presumed due to subcortical ischemia. (2) absence of cardiac sources of embolism and large artery atherosclerosis. RESULTS In 105 patients with TIA, lacunar TIA was the most frequent etiology (31%) followed by cardioembolic TIA (27%), atherothrombotic TIA (19%), undetermined etiology (18%), and other etiologies (6%). In patients with lacunar TIA, history of repeated TIA was more frequent and systolic blood pressure on admission was higher significantly than in cardioembolic TIA. Six of 105 patients had experienced recurrent stroke after TIA during admission. Among these 6 patients, 3 patients were diagnosed as lacunar infarctions. CONCLUSIONS Lacunar TIA was most common TIA subtype in the present study. It is critical to identify lacunar TIA on admission because some patients with lacunar TIAs experience early recurrent stroke.
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Affiliation(s)
- Tomoyuki Ohara
- Department of Neurology, Kyoto Second Red Cross Hospital
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Yamamoto Y, Ohara T, Hamanaka M, Hosomi A, Tamura A, Akiguchi I. Characteristics of intracranial branch atheromatous disease and its association with progressive motor deficits. J Neurol Sci 2011; 304:78-82. [PMID: 21402390 DOI: 10.1016/j.jns.2011.02.006] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2010] [Revised: 02/06/2011] [Accepted: 02/07/2011] [Indexed: 10/18/2022]
Affiliation(s)
- Yasumasa Yamamoto
- Department of Neurology, Kyoto Second Red Cross Hospital, 355-5 Haruobicho Kamigyoku, Kyoto 602, Japan.
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Yamamoto Y, Ohara T, Nagakane Y, Tanaka E, Morii F, Koizumi T. [Concept of branch atheromatous disease (BAD) and its clinical significance]. Rinsho Shinkeigaku 2010; 50:914-917. [PMID: 21921508 DOI: 10.5692/clinicalneurol.50.914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Small deep brain infarcts are often caused by two different vascular pathologies: 1. atheromatous occlusion at the orifice of large caliber penetrating arteries termed branch atheromatous disease (BAD) and 2. lipohyallinotic degenerative changes termed lipohyalinitic degeneration (LD). Atheromatous changes at the origin or proximal portion of a penetrating artery of larger caliber can be observed in infarcts of the lenticulostriate (LSA) as well as the anterior pontine arteries (APA). We studied 392 patients with penetrating artery disease in the territories of LAS and APA to evaluate predictive factors for progressive motor deficits (PMD). Prevalence of male gender, diabetes mellitus and intracranial atherosclerosis were significantly higher in the APA group than in the LSA group. Female sex and initial severity of motor deficit were common predictors for PMD in both groups. In the LSA group, single infarcts without concomitant silent lacunar infarcts and lacunar TIAs were found to be independent predictors for PMD. In the APA group, diabetes mellitus was found to be an independent predictor. Combined treatment consisting of argatroban, cilostazol, and edaravone for acute BAD type infarct significantly improved the functional outcome.
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Takeda H, Takagi M, Yamamoto Y. [Branch atheromatous disease: how do we analyze its pathophysiology and treat it to prevent the progression of neurological symptoms?]. Rinsho Shinkeigaku 2010; 50:921-924. [PMID: 21921511 DOI: 10.5692/clinicalneurol.50.921] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Branch atheromatous disease (BAD) has been recognized as one of the types of stroke which is often associated with clinical deterioration. Coagulation and platelet activation should play an important role in early neurological progression of BAD, which include complicated aspects for understanding the pathophysiology and the treatment. It has been suggested that multidrug combination therapy involving antiplatelet and anticoagulation could not prevent worsening of symptoms in the acute stage of BAD: nevertheless it should be important to improve prognosis of patients in the chronic stage. Further investigation including randomized controlled study will be needed for the accumulation of various evidences.
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Affiliation(s)
- Hidetaka Takeda
- Department of Neurology and Cerebrovascular Medicine, Saitama International Medical Center, Saitama Medical University
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Taguchi Y, Takashima S, Nukui T, Dougu N, Toyoda S, Tanaka K. [Case of branch atheromatous disease presenting capsular warning syndrome]. Rinsho Shinkeigaku 2010; 50:320-4. [PMID: 20535981 DOI: 10.5692/clinicalneurol.50.320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report a case of branch atheromatous disease (BAD) presenting capsular warning syndrome, who subsequently showed a complete recovery by the combination therapy as described below. A 54-year-old man with untreated hypertension was admitted to our hospital because of dysarthria and right hemiplegia. The NIHSS on admission was 12 points, but his symptoms soon completely disappeared during examination. After admission administration of aspirin, heparin, atorvastatin and t-PA were started, but stereotyped episodes of dysarthria and the right hemiplegia occurred repeatedly. We added plasma expander, and he thereafter revealed no further ischemic episodes at 22 hours from admission. Over all, he had 15 times of transient ischemic attack with no lasting deficit. The DWI scan obtained 5 hours after the onset demonstrated a high-intensity region in the left putamen to corona radiata. MRA showed no significant abnormalities. He had been diagnosed as having branch atheromatous disease with capsular warning syndrome. The present case suggests that combination therapy including t-PA and plasma expander may be effective to BAD presenting capsular warning syndrome.
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Ohara T, Yamamoto Y, Tamura A, Ishii R, Murai T. The infarct location predicts progressive motor deficits in patients with acute lacunar infarction in the lenticulostriate artery territory. J Neurol Sci 2010; 293:87-91. [DOI: 10.1016/j.jns.2010.02.027] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Revised: 02/25/2010] [Accepted: 02/26/2010] [Indexed: 11/30/2022]
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