Zhou Lixin, Yao Ming, Peng Bin, Zhu Yicheng, Ni Jun, Cui Liying
Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Neuroscience Center, Chinese Academy of Medical Sciences, Beijing, China.
Front Neurol. 2018 Oct 9;9:840. doi: 10.3389/fneur.2018.00840. eCollection 2018.
To investigate an MRI-based etiological classification for acute isolated pontine infarcts and to assess differences in vascular risk factors, clinical characteristics and WMH burden among the etiological subtypes. All participants from SMART cohort with DWI-proven acute isolated pontine infarcts (AIPI) were included and categorized into 3 groups: large-artery-occlusive disease (LAOD), basilar artery branch disease (BAD), and small vessel disease (SVD), according to basilar artery atherosclerosis severity and lesion extent of the transverse axial plane. The vascular risk factors and 6-month functional outcome was analyzed among 3 groups. Of the 1129 patients enrolled, 175 had AIPI. BAD was the most frequent subtype of AIPI (46.3%), followed by SVD (36.0%) and LAOD (17.7%). Neurological impairment on admission was more severe in the LAOD group, followed by BAD. The BAD group had greater frequencies of female sex, hypertension, diabetes mellitus compared to the SVD group ( < 0.05). NIHSS on admission were significantly higher in the BAD group as compared with the SVD group ( < 0.001), but no difference was found between BAD and LAOD group. Poor outcome (mRS≥3) was found in only 13.7% of patients at 6-month post-stroke and there was no difference among 3 groups. WMH severity was significant higher in the SVD group compared to the BAD group for the deep subcortical region; however, there was no difference for the periventricualr region. There was no significant difference in either DWMH or PVWMH severity between the BAD and LAOD groups. BAD is the most frequent etiology of AIPI followed by SVD and LAOD. WMH burden, vascular risk factors and clinical characteristics in BAD group were more similar to the LAOD group, rather than to the SVD group, suggesting the atherothrombotic nature of BAD.
研究基于磁共振成像（MRI）的急性孤立性脑桥梗死病因分类，并评估不同病因亚型之间血管危险因素、临床特征和脑白质高信号（WMH）负荷的差异。纳入SMART队列中所有经弥散加权成像（DWI）证实的急性孤立性脑桥梗死（AIPI）患者，并根据基底动脉粥样硬化严重程度和横轴位病变范围分为3组：大动脉闭塞性疾病（LAOD）、基底动脉分支疾病（BAD）和小血管疾病（SVD）。分析3组患者的血管危险因素和6个月功能转归情况。在纳入的1129例患者中，175例患有AIPI。BAD是AIPI最常见的亚型（46.3%），其次是SVD（36.0%）和LAOD（17.7%）。LAOD组入院时神经功能缺损更严重，其次是BAD组。与SVD组相比，BAD组女性、高血压、糖尿病的发生率更高（P<0.05）。BAD组入院时美国国立卫生研究院卒中量表（NIHSS）评分显著高于SVD组（P<0.001），但BAD组与LAOD组之间无差异。卒中后6个月时，仅13.7%的患者预后不良（改良Rankin量表[mRS]≥3），3组之间无差异。SVD组深部皮质下区域的WMH严重程度显著高于BAD组；然而在脑室周围区域两组无差异。BAD组和LAOD组在深部白质高信号（DWMH）或脑室周围白质高信号（PVWMH）严重程度方面均无显著差异。BAD是AIPI最常见的病因，其次是SVD和LAOD。BAD组的WMH负荷、血管危险因素和临床特征与LAOD组更相似，而非与SVD组相似，提示BAD的动脉粥样硬化血栓形成性质。
