Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, No. 16766 Jingshi Road, Jinan, 250013, Shandong, China.
Department of Neurology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, No. 16766 Jingshi Road, Jinan, 250013, Shandong, China.
BMC Neurol. 2023 Aug 11;23(1):298. doi: 10.1186/s12883-023-03351-y.
Early neurological deterioration (END) sometimes occurs in patients with penetrating artery territory infarction (PATI) and leads to poor prognosis. In this study, we analyzed clinical and neuroimaging characteristics of PATI, and focused on the infarct patterns on diffusion-weighted imaging (DWI). We tried to investigate whether the "island sign" pattern is associated with END.
We enrolled consecutive patients admitted with acute PATI within 48 h after onset from May 2020 to July 2022. They were divided into with and without the "island sign" pattern on DWI. According to infarct location, all the patients were classified into two groups: the territories of the lenticulostriate arteries (LSA) and paramedian pontine arteries (PPA). The patients in each group were further divided into two groups according to whether they developed END or not. Through analyzing the clinical and neuroimaging characteristics of the patients, we tried to identify the factors that might associated with the "island sign" pattern and the potential predictors of END within the LSA and PPA groups.
Out of the 113 patients enrolled in this study, END was found in 17 patients (27.9%) in the LSA group and 20 patients (38.5%) in the PPA group. The "island sign" was found in 26 (23%) patients. In the multivariate analysis, the independent predictors of END in the LSA group were the "island sign" (OR 4.88 95% CI 1.03-23.2 P = 0.045) and high initial National Institute of Health Stroke Scale (NIHSS) (OR 1.79 95% CI 1.08-2.98 P = 0.024) and in the PPA group was the presence of lesions extending to the ventral pontine surface (OR 7.53 95% CI 1.75-32.37 P = 0.007).
The predictive factors for END were different in the LSA and PPA groups. The "island sign" was particularly associated with END in the LSA group.
穿透动脉供血区梗死（PATI）患者有时会出现早期神经功能恶化（END），导致预后不良。本研究分析了 PATI 的临床和神经影像学特征，并重点关注弥散加权成像（DWI）上的梗死模式。我们试图探讨“岛征”模式是否与 END 有关。
我们连续纳入了 2020 年 5 月至 2022 年 7 月发病 48 小时内入院的急性 PATI 患者。根据 DWI 上是否存在“岛征”模式，将他们分为有和无“岛征”模式两组。根据梗死部位，将所有患者分为纹状体动脉（LSA）和旁正中脑桥动脉（PPA）两组。每组患者再根据是否发生 END 分为两组。通过分析患者的临床和神经影像学特征，我们试图确定与“岛征”模式相关的因素，以及 LSA 和 PPA 两组中 END 的潜在预测因素。
本研究共纳入 113 例患者，其中 LSA 组 END 患者 17 例（27.9%），PPA 组 20 例（38.5%）。26 例（23%）患者存在“岛征”。多因素分析显示，LSA 组 END 的独立预测因素为“岛征”（OR 4.88，95%CI 1.03-23.2，P=0.045）和较高的初始国立卫生研究院卒中量表（NIHSS）评分（OR 1.79，95%CI 1.08-2.98，P=0.024），而 PPA 组的预测因素为累及脑桥腹侧面的病灶（OR 7.53，95%CI 1.75-32.37，P=0.007）。
LSA 和 PPA 两组 END 的预测因素不同。“岛征”与 LSA 组的 END 特别相关。
