Nakamura K, Saku Y, Ibayashi S, Fujishima M
Department of Cerebrovascular Disease, Institute of Neuroscience, St. Mary's Hospital, Kurume, Japan.
Neurology. 1999 Jan 1;52(1):29-33. doi: 10.1212/wnl.52.1.29.
To study the clinical characteristics of the progression of motor deficits in lacunar stroke patients.
Some patients with lacunar infarction have progression of their neurologic deficits, but it is not known which patients will progress or why they progress.
The authors evaluated 92 consecutive patients (47 men, 45 women; age, 69.4 +/- 10.9 years [mean +/- SD]) with first-ever stroke due to supratentorial lacunes in the internal capsule or the corona radiata. By defining lacunar infarction in which motor deficits progressed between admission and the day after admission as progressive lacunar infarction, the authors compared progressive lacunar infarction with stable lacunar infarction.
Of 92 patients, 25 (27%) had progression of deficits. Diabetes mellitus (p = 0.02) and severity of motor deficit on admission (p = 0.006) were related independently to progression in a logistic multiple regression analysis. Size of the infarct was slightly larger (1.2 +/- 0.4 cm2 versus 0.9 +/- 0.5 cm2; p = 0.01) and functional status at discharge was worse (median Barthel index, 45 versus 100; p < 0.001) in patients with progressive infarction than in those without progression. There were no significant differences between the two groups regarding the site of the infarct or blood pressure or hematocrit levels on or after admission.
The progression of motor deficits is associated with a relatively poor functional outcome. Diabetes mellitus and the severity of motor deficit on admission may predict progression of motor deficits.
研究腔隙性脑梗死患者运动功能缺损进展的临床特征。
部分腔隙性脑梗死患者存在神经功能缺损进展，但尚不清楚哪些患者会进展以及进展的原因。
作者评估了92例首次因幕上内囊或放射冠腔隙性梗死导致卒中的连续患者（47例男性，45例女性；年龄69.4±10.9岁[均值±标准差]）。通过将入院时与入院后次日之间运动功能缺损出现进展的腔隙性梗死定义为进展性腔隙性梗死，作者对进展性腔隙性梗死与稳定性腔隙性梗死进行了比较。
92例患者中，25例（27%）出现功能缺损进展。在逻辑多元回归分析中，糖尿病（p = 0.02）和入院时运动功能缺损的严重程度（p = 0.006）与进展独立相关。进展性梗死患者的梗死灶大小略大（1.2±0.4 cm² 对 0.9±0.5 cm²；p = 0.01），出院时功能状态更差（Barthel指数中位数，45对100；p < 0.001）。两组在梗死部位、入院时或入院后血压及血细胞比容水平方面无显著差异。
运动功能缺损进展与相对较差的功能结局相关。糖尿病和入院时运动功能缺损的严重程度可能预测运动功能缺损的进展。
