From the Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea (H.-G.J.) and Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea (B.J.K., M.H.Y., M.-K.H., H.-J.B.).
Stroke. 2015 Mar;46(3):687-91. doi: 10.1161/STROKEAHA.114.007466. Epub 2015 Feb 12.
Early neurological deterioration (END) occurs in ≥20% of single small subcortical infarctions (SSSIs; axial diameter ≤20 mm in the perforator territories) and deters functional recovery. Both microvasculopathies and atherosclerosis have been proposed to independently contribute to the occurrence of END in SSSI cases. We hypothesized that the occurrence of END in SSSIs differs according to the pathological process.
We collected data from 587 patients with SSSI within 48 hours of onset from a prospective stroke registry containing 4961 case records. Independent reviewers, blinded to END information, rated neuroimaging characteristics, including relevant artery stenosis (0% to 50% stenosis of the adjacent arteries on magnetic resonance angiography), branch atheromatous lesions (≥4 consecutive axial cuts or extensions from the basal surface of the pons), white matter hyperintensities, old lacunar infarctions, and cerebral microbleeds.
END occurred in 79 (13.5%) cases, including 6 recurrences, 68 progressions, 1 symptomatic hemorrhagic transformation, 1 others, and 3 unknowns. END increased the National Institutes of Health Stroke Scale score by 2.3±1.4 points. Patients with END showed higher frequencies of modified Rankin Scale scores of 3 to 6 after 3 months compared with patients without END (49% versus 23%). Patients with relevant artery stenosis (adjusted odds ratio, 1.91; 95% confidence interval, 1.13-3.21) and branch atheromatous lesions (adjusted odds ratio, 2.98; 95% confidence interval, 1.80-4.93) had significantly higher odds of exhibiting END. However, such an association was not detected with small vessel disease markers.
Our analysis indicated a potential contribution of the localized atherosclerotic process to END in SSSIs. Precautionary measures might be used for SSSIs suggestive of atherosclerotic pathologies.
早期神经功能恶化（END）发生在≥20%的单发小皮质下梗死（SSSI；穿支血管支配区的轴径≤20mm），并阻碍了功能恢复。微血管病变和动脉粥样硬化都被认为独立地导致 SSSI 患者 END 的发生。我们假设 SSSI 中 END 的发生与病理过程不同。
我们从一个包含 4961 例病例的前瞻性卒中登记处收集了 587 例 SSSI 发病后 48 小时内的患者数据。独立的评审员对神经影像学特征进行了盲评，包括相关动脉狭窄（磁共振血管造影显示相邻动脉狭窄 0%至 50%）、分支粥样硬化病变（≥4 个连续的轴向切面或从脑桥底部延伸）、脑白质高信号、陈旧腔隙性梗死和脑微出血。
79 例（13.5%）患者发生 END，其中 6 例复发，68 例进展，1 例症状性出血性转化，1 例其他，3 例未知。END 使 NIHSS 评分增加了 2.3±1.4 分。与无 END 患者相比，END 患者在 3 个月后出现改良 Rankin 量表评分 3 至 6 分的频率更高（49%比 23%）。有相关动脉狭窄（调整后的优势比，1.91；95%置信区间，1.13-3.21）和分支粥样硬化病变（调整后的优势比，2.98；95%置信区间，1.80-4.93）的患者发生 END 的可能性显著增加。然而，这种关联在小血管疾病标志物中没有被检测到。
我们的分析表明，局部动脉粥样硬化过程可能导致 SSSI 中的 END。对于提示动脉粥样硬化病变的 SSSI，可能需要采取预防措施。
