Comprehensive Stroke Center, Department of Neuroscience, Hospital Clínic of Barcelona. Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain..
Department of Neurology, Hospital Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Spain..
J Stroke Cerebrovasc Dis. 2021 Jul;30(7):105824. doi: 10.1016/j.jstrokecerebrovasdis.2021.105824. Epub 2021 Apr 25.
Recent small subcortical infarcts (RSSI) are considered an acute manifestation of cerebral small vessel disease (CSVD). We assessed whether the topography of RSSI was related to CSVD markers on magnetic resonance imaging (MRI).
We screened the local registries of two independent stroke centers in Catalonia and selected patients with a symptomatic RSSI on MRI performed during admission. RSSI location was classified into brainstem, supratentorial subcortical structures (SSS), and centrum semiovale (CSO) regions. Clinical variables, including vascular risk factors, were collected. Radiological markers of CSVD on MRI were evaluated individually and by means of the global CSVD burden score. The associations between each RSSI location and CSVD markers were studied in uni- and multivariate logistic regression analysis.
Among 475 patients with RSSI, 152 (32%) had an infarct in the brainstem, 227 (48%) in SSS, and 96 (20%) in CSO region. The median CSVD burden score was 2 (IQR, 1-3). After adjusting for confounding factors, a RSSI in CSO was associated with higher periventricular and deep white matter hyperintensity scores [OR 1.64 (95% CI, 1.16-2.33), and OR 1.44 (95% CI, 1.07-1.93), respectively]. Higher CSVD burden score was positively associated with CSO [OR 1.48 (95% CI, 1.22-1.81)] and inversely associated with SSS [0.85 (95% CI, 0.72-0.99)] location after adjusting for relevant confounders.
CSO RSSI were related to a higher burden of CSVD, particularly to white matter hyperintensities, compared to other RSSI locations. The pathophysiological significance of such findings should be investigated in the future with advanced neuroimaging techniques.
最近的小皮质下梗死（RSSI）被认为是脑小血管疾病（CSVD）的急性表现。我们评估了 RSSI 的位置是否与 MRI 上的 CSVD 标志物有关。
我们筛选了加泰罗尼亚两个独立卒中中心的本地登记册，并选择了在入院期间 MRI 上出现有症状的 RSSI 的患者。RSSI 位置分为脑干、皮质下结构（SSS）和半卵圆中心（CSO）区域。收集了临床变量，包括血管危险因素。单独评估 MRI 上 CSVD 的放射学标志物，并通过整体 CSVD 负担评分进行评估。在单变量和多变量逻辑回归分析中研究了每个 RSSI 位置与 CSVD 标志物之间的关系。
在 475 例 RSSI 患者中，152 例（32%）脑干梗死，227 例（48%）皮质下结构梗死，96 例（20%）半卵圆中心梗死。中位数 CSVD 负担评分为 2（IQR，1-3）。调整混杂因素后，CSO 中的 RSSI 与更高的脑室周围和深部白质高信号评分相关[OR 1.64（95%CI，1.16-2.33）和 OR 1.44（95%CI，1.07-1.93）]。更高的 CSVD 负担评分与 CSO 呈正相关[OR 1.48（95%CI，1.22-1.81）]，与 SSS 呈负相关[0.85（95%CI，0.72-0.99）]，在调整相关混杂因素后。
与其他 RSSI 部位相比，CSO 的 RSSI 与更高的 CSVD 负担有关，特别是与脑白质高信号有关。未来应使用先进的神经影像学技术进一步研究这些发现的病理生理学意义。
