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Current Neurovascular Research

Editor-in-Chief

ISSN (Print): 1567-2026
ISSN (Online): 1875-5739

Research Article

Prediction of Symptoms on Admission with Early Neurological Deterioration in Single Small Subcortical Infarct

Author(s): Ce Zong, Hongbing Liu, Ke Zhang, Hongxun Yang, Anran Wang, Yunchao Wang, Hanghang Zhu, Yapeng Li, Kai Liu, Bo Song, Yuming Xu and Yuan Gao*

Volume 19, Issue 2, 2022

Published on: 01 August, 2022

Page: [232 - 239] Pages: 8

DOI: 10.2174/1567202619666220707094342

Price: $65

Abstract

Background: Early neurological deterioration (END) often occurs during hospitalization in single small subcortical infarct (SSSI). While, symptoms on admission were rarely reported about its performance on predicting the risk of END.

Objectives: The objective of this study is to explore the relationship between symptoms on admission and END in SSSI.

Methods: Patients with SSSI in the lenticulostriate artery (LSA) territory presenting within 72 hours of stroke onset were screened prospectively. Clinical characteristics, including symptoms on admission, laboratory tests and imaging findings, were collected. Based on the body regions involved including spherical face (SF), upper limb (UL) or lower limb (LL), symptoms on admission were classified into single spherical face (sSF) and any involvement of limbs (AL). END was defined as ≥2 points increase in total National Institutes of Health Stroke Scale (NIHSS) score or ≥ 1 point increase in motor score within 72 hours after admission. Multivariate logistic regression was used to analyze factors associated with END.

Results: Out of 5,832 ischemic stroke patients in the database, 394 patients were finally enrolled in analysis. 65 patients (16.5%) developed END. Multivariable logistic regression revealed that symptoms with LL (OR 2.337, 95% CI 1.041-5.246), UL (OR 2.936, 95% CI 1.349-6.390) were both associated with END, while the involvement of SF (OR 0.447, 95% CI 0.249-0.804) showed the opposite result. Further analysis found that symptoms with AL (OR 3.958, 95% CI 1.355-11.565) showed a higher risk of END compared to sSF after adjustment.

Conclusion: Our results discovered that symptoms with AL carried a higher risk of END than those involving sSF in SSSI.

Keywords: Single small subcortical infarct, early neurological deterioration, symptoms on admission, lenticulostriate artery, posterior type, motor deficits, single spherical face.

« Previous
[1]
Jeong HG, Kim BJ, Yang MH, Han MK, Bae HJ. Neuroimaging markers for early neurologic deterioration in single small subcortical infarction. Stroke 2015; 46(3): 687-91.
[http://dx.doi.org/10.1161/STROKEAHA.114.007466] [PMID: 25677600]
[2]
Yang X, Pu Y, Liu L, et al. The infarct location predicts the outcome of single small subcortical infarction in the territory of the middle cerebral artery. J Stroke Cerebrovasc Dis 2014; 23(6): 1676-81.
[3]
Nam KW, Kwon HM, Lee YS. Different predictive factors for early neurological deterioration based on the location of single subcortical infarction: Early prognosis in single subcortical infarction. Stroke 2021; 52(10): 3191-8.
[http://dx.doi.org/10.1161/STROKEAHA.120.032966] [PMID: 34176312]
[4]
Del Bene A, Palumbo V, Lamassa M, Saia V, Piccardi B, Inzitari D. Progressive lacunar stroke: Review of mechanisms, prognostic features, and putative treatments. J Stroke Cerebrovasc Dis 2012; 7(4): 321-9.
[5]
Nakamura K, Saku Y, Ibayashi S, Fujishima M. Progressive motor deficits in lacunar infarction. Neurology 1999; 52(1): 29-33.
[http://dx.doi.org/10.1212/WNL.52.1.29] [PMID: 9921844]
[6]
Yamamoto N, Terasawa Y, Satomi J, et al. Predictors of neurologic deterioration in patients with small-vessel occlusion and infarcts in the territory of perforating arteries. J Stroke Cerebrovasc Dis 2014; 23(8): 2151-5.
[7]
Cho KH, Kang DW, Kwon SU, Kim JS. Lesion volume increase is related to neurologic progression in patients with subcortical infarction. J Neurol Sci 2009; 284(1-2): 163-7.
[http://dx.doi.org/10.1016/j.jns.2009.05.013] [PMID: 19497589]
[8]
Vynckier J, Maamari B, Grunder L, et al. Early neurologic deterioration in lacunar stroke: Clinical and imaging predictors and association with long-term outcome. Neurology 2021. Epub ahead of print
[http://dx.doi.org/10.1212/WNL.0000000000012661] [PMID: 34400585]
[9]
Zhang C, Wang Y, Zhao X, et al. Distal single subcortical infarction had a better clinical outcome compared with proximal single subcortical infarction. Stroke 2014; 45(9): 2613-9.
[http://dx.doi.org/10.1161/STROKEAHA.114.005634] [PMID: 25052317]
[10]
Castellanos M, Castillo J, García MM, et al. Inflammation-mediated damage in progressing lacunar infarctions: A potential therapeutic target. Stroke 2002; 33(4): 982-7.
[http://dx.doi.org/10.1161/hs0402.105339] [PMID: 11935048]
[11]
Feng C, Tan Y, Wu YF, et al. Leukoaraiosis correlates with the neurologic deterioration after small subcortical infarction. J Stroke Cerebrovasc Dis 2014; 23(6): 1513-8.
[12]
Kwon HM, Lim JS, Park HK, Lee YS. Hypertriglyceridemia as a possible predictor of early neurological deterioration in acute lacunar stroke. J Neurol Sci 2011; 309(1-2): 128-30.
[http://dx.doi.org/10.1016/j.jns.2011.06.057] [PMID: 21784458]
[13]
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(1-2): 87-91.
[http://dx.doi.org/10.1016/j.jns.2010.02.027] [PMID: 20334882]
[14]
Kim JP, Kim SJ, Lee JJ, et al. Diffusion-perfusion mismatch in single subcortical infarction: A predictor of early neurological deterioration and poor functional outcome. Eur Neurol 2015; 73(5-6): 353-9.
[http://dx.doi.org/10.1159/000430461] [PMID: 26021692]
[15]
Duan Z, Sun W, Liu W, et al. Acute diffusion-weighted imaging lesion patterns predict progressive small subcortical infarct in the perforator territory of the middle cerebral artery. J Stroke Cerebrovasc Dis 2015; 10(2): 207-12.
[16]
Yu YP, Tan L. The infarct shape predicts progressive motor deficits in patients with acute lacunae-sized infarctions in the perforating arterial territory. Intern Med 2015; 54(23): 2999-3004.
[http://dx.doi.org/10.2169/internalmedicine.54.4442] [PMID: 26631882]
[17]
Nagakane Y, Naritomi H, Oe H, Nagatsuka K, Yamawaki T. Neurological and MRI findings as predictors of progressive-type lacunar infarction. Eur Neurol 2008; 60(3): 137-41.
[http://dx.doi.org/10.1159/000144084] [PMID: 18628632]
[18]
Song YM. Somatotopic organization of motor fibers in the corona radiata in monoparetic patients with small subcortical infarct. Stroke 2007; 38(8): 2353-5.
[http://dx.doi.org/10.1161/STROKEAHA.106.480632] [PMID: 17569873]
[19]
Kim JS, Pope A. Somatotopically located motor fibers in corona radiata: evidence from subcortical small infarcts. Neurology 2005; 64(8): 1438-40.
[http://dx.doi.org/10.1212/01.WNL.0000158656.09335.E7] [PMID: 15851738]
[20]
Yamamoto Y, Nagakane Y, Tomii Y, Toda S, Akiguchi I. The relationship between progressive motor deficits and lesion location in patients with single infarction in the lenticulostriate artery territory. J Neurol 2017; 264(7): 1381-7.
[http://dx.doi.org/10.1007/s00415-017-8533-9] [PMID: 28597318]
[21]
Pathogenic heterogeneity of distal single small subcortical lenticulostriate infarctions based on lesion size. J Stroke Cerebrovasc Dis 2016; 25-14(1): 1-14.
[22]
Kitanaka C, Teraoka A. Clinical features of progressive lacunar infarction retrospective analysis of patients with motor syndromes. Neurol Med Chir (Tokyo) 1995; 35(9): 663-6.
[http://dx.doi.org/10.2176/nmc.35.663] [PMID: 7566399]

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