Department of Neurology, Chonnam National University Hospital, Gwanju, Korea.
Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Tottori, Japan.
PLoS One. 2020 Mar 11;15(3):e0229836. doi: 10.1371/journal.pone.0229836. eCollection 2020.
We hypothesized that admission insular infarcts could be associated with early neurological deterioration (END) in acute minor stroke with large vessel occlusion.
Using acute and follow-up diffusion-weighted imaging (DWI), we assessed insular involvement including the percent insular ribbon infarction (PIRI) scores and follow-up lesion patterns in acute minor stroke (NIHSS ≤5) with MCA/ICA occlusion. Follow-up lesion patterns were classified as swelling, new lesions, or infarct growth. END was defined as any increase in the NIHSS score.
Among 166 patients (age: 66±12 y, 60.8% male), 82 (49.4%) had insular lesions on baseline DWI, and 64 (38.6%) had PIRI scores ≥2. On follow-up DWI, infarct growths, new lesions, and swelling were observed in 34.9%, 69.9%, and 29.5% of patients. Infarct growths were significantly more frequent in patients with insular infarcts (43.9%), especially those with a PIRI score of 2 (54.8%), than in patients without insular infarcts (p = 0.02). While END was not significantly different in patients with and without insular lesions, insular lesions were independently associated with infarct growths (OR 2.18, 95% CI 1.12-4.26, p = 0.02) and END due to infarct growth (OR 2.54, 95% CI 1.12-5.76, p = 0.03), particularly in those with PIRI scores ≥2.
In acute minor stroke with MCA/ICA occlusion, insular lesions on admission DWI, especially in patients with PIRI scores ≥2, were more likely to exhibit infarct growth and END due to infarct growth. This finding may help identify patients with higher risks of clinical worsening following acute minor stroke with large vessel occlusion.
我们假设，在伴有大血管闭塞的急性小卒中等，岛叶梗死与早期神经功能恶化（END）相关。
利用急性和随访弥散加权成像（DWI），我们评估了急性小卒中等（NIHSS≤5）伴有 MCA/ICA 闭塞患者的岛叶受累情况，包括岛叶带梗死比例（PIRI）评分和随访病变模式。随访病变模式分为肿胀、新发病灶或梗死进展。END 定义为 NIHSS 评分的任何增加。
在 166 例患者中（年龄：66±12 岁，60.8%为男性），82 例（49.4%）在基线 DWI 上有岛叶病变，64 例（38.6%）有 PIRI 评分≥2。在随访 DWI 上，34.9%、69.9%和 29.5%的患者分别观察到梗死进展、新发病灶和肿胀。岛叶梗死患者中梗死进展更为常见（43.9%），尤其是 PIRI 评分≥2 的患者（54.8%），而非无岛叶梗死患者（p=0.02）。虽然伴有和不伴有岛叶病变的患者 END 无显著差异，但岛叶病变与梗死进展独立相关（OR 2.18，95%CI 1.12-4.26，p=0.02），并与梗死进展导致的 END 相关（OR 2.54，95%CI 1.12-5.76，p=0.03），尤其是 PIRI 评分≥2 的患者。
在伴有 MCA/ICA 闭塞的急性小卒中患者中，入院 DWI 上的岛叶病变，特别是 PIRI 评分≥2 的患者，更有可能出现梗死进展和梗死进展导致的 END。这一发现可能有助于识别伴有大血管闭塞的急性小卒中患者中临床恶化风险较高的患者。
