Patients of small subcortical infarction sometimes have neurologic deterioration (ND), with the risk factors and specific pathogenesis unclear. Small subcortical infarction is often accompanied by other phenotypes of small vessel disease such as leukoaraiosis, which indicates the white matter hyperintensities in the deep or periventricular areas on the fluid-attenuated inversion recovery series of magnetic resonance images and was proved to be associated with stroke in various aspects. In this study, we intended to investigate whether leukoaraiosis was associated with ND after small subcortical infarction, and explore other possible risk factors of ND.
Patients with single acute subcortical infarction (<1.5 cm in diameter) were recruited consecutively and evaluated everyday. ND was defined as worsening by 2 points or more in the National Institutes Health Stroke Scale (NIHSS) score, or by 1 point or more in the NIHSS score for motor function within 1 week after stroke onset. Leukoaraiosis was rated according to the age-related white matter changes scale. Univariate and multivariate analyses were performed to identify the risk factors for ND.
Eighty-four of 435 patients (19.31%) had ND. Univariate analysis showed that age, severity of leukoaraiosis, baseline NIHSS score, presence of diabetes, hemoglobin A1c, and total cholesterol levels were all associated with ND. Multivariate analysis further identified that the severity of leukoaraiosis especially leukoaraiosis adjacent to the index infarction, baseline NIHSS score, and diabetes were independently associated with ND.
Severity of leukoaraiosis and baseline neurologic deficits, and the presence of diabetes were all independently associated with ND after small subcortical infarction.
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- Lacunar stroke.Expert Rev Neurother. 2009; 9: 179-196
- Lacunar stroke is the major cause of progressive motor deficits.Stroke. 2002; 33: 1510-1516
- Intracranial branch atheromatous disease: a neglected, understudied, and underused concept.Neurology. 1989; 39: 1246-1250
- Branch atheromatous plaque: a major cause of lacunar infarction (high-resolution MRI study).Cerebrovasc Dis Extra. 2012; 2: 36-44
- Clinical evaluation of lacunar infarction and branch atheromatous disease.J Stroke Cerebrovasc Dis. 2013; 22: 406-412
- Characteristics of intracranial branch atheromatous disease and its association with progressive motor deficits.J Neurol Sci. 2011; 304: 78-82
- Progressive lacunar stroke: review of mechanisms, prognostic features, and putative treatments.Int J Stroke. 2012; 7: 321-329
- Cerebral small vessel disease: a review of clinical, radiological, and histopathological phenotypes.Int J Stroke. 2012; 7: 36-46
- Lacunar versus non-lacunar syndromes.Front Neurol Neurosci. 2012; 30: 94-98
- MRI findings of small subcortical “lacunar-like” infarction resulting from large vessel disease.J Neurol. 2000; 247: 280-285
- Leukoaraiosis and stroke.Stroke. 2010; 41: S139-S143
- Silent brain infarcts and white matter lesions increase stroke risk in the general population: The Rotterdam Scan Study.Stroke. 2003; 34: 1126-1129
- Hypertriglyceridemia as a possible predictor of early neurological deterioration in acute lacunar stroke.J Neurol Sci. 2011; 309: 128-130
- Demographic, clinical, and radiologic predictors of neurologic deterioration in patients with acute ischemic stroke.J Stroke Cerebrovasc Dis. 2013; 22: 205-210
- Predictors of early clinical deterioration after acute ischemic stroke.Am J Emerg Med. 2011; 29: 577-581
- Lacunes: small, deep cerebral infarcts.Neurology. 1965; 15: 774-784
- Penetrating artery territory pontine infarction.Rev Neurol Dis. 2011; 8: 30-38
- Executive summary: standards of medical care in diabetes–2011.Diabetes Care. 2011; 34: S4-S10
- Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III).JAMA. 2001; 285: 2486-2497
- Age-related white matter changes.J Aging Res. 2011; 2011: 1-13
- A new rating scale for age-related white matter changes applicable to MRI and CT.Stroke. 2001; 32: 1318-1322
- The age-related white matter changes scale correlates with cognitive impairment.Eur J Neurol. 2010; 17: 1451-1456
- Age-related cerebral white matter disease (leukoaraiosis): a review.Postgrad Med J. 2012; 88: 79-87
- Clinical, radiological and pathological correlates of leukoaraiosis.Acta Neurol Scand. 2011; 123: 41-47
- Common genetic variants of the mitochondrial trafficking system and mitochondrial uncoupling proteins affect the development of two slowly developing demyelinating disorders, leukoaraiosis and multiple sclerosis.Curr Med Chem. 2010; 17: 3583-3590
- Neurochemical correlates of cognitive dysfunction in patients with leukoaraiosis: a proton magnetic resonance spectroscopy study.Neurol Res. 2012; 34: 989-997
- Blood-brain barrier permeability abnormalities in vascular cognitive impairment.Stroke. 2011; 42: 2158-2163
- Micro-blood-brain barrier openings and cytotoxic fragments of amyloid precursor protein accumulation in white matter after ischemic brain injury in long-lived rats.Acta Neurochir Suppl. 2006; 96: 267-271
- Severity of leukoaraiosis and susceptibility to infarct growth in acute stroke.Stroke. 2008; 39: 1409-1413
- Diffusion tensor MR imaging in neurofibromatosis type 1: expanding the knowledge of microstructural brain abnormalities.Pediatr Radiol. 2012; 42: 449-454
- Predictors of life-threatening brain edema in middle cerebral artery infarction.Cerebrovasc Dis. 2008; 25: 176-184
- Early neurological deterioration (END) after stroke: the END depends on the definition.Int J Stroke. 2011; 6: 211-212
Published online: March 03, 2014
Accepted: December 18, 2013
Received in revised form: December 3, 2013
Received: November 13, 2013
© 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.