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Objective To investigate the relationship between white-matter hyperintensities (WMHs) and hemorrhagic transformation and neurological outcome at 3 months after recombinant tissue plasminogen activator (rt-PA) treatment in patients with acute ischemic stroke.Methods The chnical data of 132 patients with acute ischemic stroke who had received intravenous rt-PA therapy were retrospectively reviewed.The severity of WMHs according to the modified Schelten scale was assessed.Hemorrhagic transformation included hemorrhagic infarct (HI) and cerebral parenchymal hemorrhage (PH).Hemorrhagic transformation after thrombolytic therapy and clinical neurological outcome based on modified Rankin scale (mRS) at 3 months was also analyzed.Favorable neurological outcome as mRS 0-1 score and unfavorable neurological outcome as mRS 2-6 scores was defined.Results Hemorrhagic transformation was found in 26 patients (19.7％,26/132) among 132 patients receiving intravenous rt-PA treatment.Seventeen patients were HI type and 9 patients were PH type.Multiple Logistic regression analysis showed that baseline American National Institute of Health Stroke Scale (NIHSS) score,diastolic pressure,WMHs score was not correlated with HI type hemorrhagic transformation (P ＞ 0.05) ; and WMHs score was not correlated with PH type hemorrhagic transformation (P ＞0.05),but baseline NIHSS score,diastolic pressure was the independent risk factor of PH type hemorrhagic transformation (P ＜ 0.05).Dicho-Logistic regression analysis showed that WMHs score was the independent risk factor of unfavorable neurological outcome (OR =1.136,95％ CI 1.037-1.245,P =0.008).Conclusion Severe WMHs are not associated with hemorrhagic transformation but independently associated with unfavorable neurological outcome after thrombolytic therapy in patients with acute ischemic stroke.
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Objeetive To explore the correlative factors of early progressive motor deficits in cerebral infarction of moderately size in basal ganglia and the relationship between motor deficit progression and the stem lesion of middle cerebral artery.Methods One hundred and fifty patients with single acute infarction located in white matter of basal ganglia region were recruited in this study retrospectively.All patients were performed brain and neck MRI and magnetic resonance angiography (MRA) within 72 h after onset.They were divided into two groups based on the maximal diameter of infarction on diffuse weighing imaging(DWI):moderate size infarction group(75 patients,maximal diameter of infarction from 1.5 cm to 3.0 cm) and lacunar infarction group(75 patients,maximal diameter of infarction lower than 1.5 cm).The scores of dynamic National Institutes of Health Stroke Scale(NIHSS) in 7 d after the admission and multiple Logistic regression analysis were used and the risk factors of the early progressive motor deficits were analyzed.Results The rate of early progressive motor deficits in moderate size infarction group was significant higher than that in lacunar infarction group [32.0 ％ (24/75) vs.8.0 ％ (6f75)] (P ＜ 0.05).The multiple Logistic regression analysis showed that elevated systolic blood pressure on admission was the independent risk factor for early progressive motor deficits (P =0.016).The rate of stem lesion of middle cerebral artery in moderate size infarction group was significantly higher than that in lacunar infarction group [41.3 ％ (31/75) vs.9.3 ％ (7/75)] (P ＜ 0.01).Conclusions Patients with acute single infarction located in white matter of basal ganglia and with the diameter of 1.5-3.0 cm are more prone to early progressive motor deficits and elevated systolic blood pressure on admission is the most significantly independent factor.The pathogenic mechanism may be associated with the stem lesion of middle cerebral artery.