Infarction location for predicting cerebral infarction progressive motor nerve function deficits in middle cerebral artery area / 重庆医学

Objective To investigate the correlation between the infarction location and progressive motor deficits (PMD) occurrence.Methods The patients with middle cerebral artery(MCA) infarction within 24 h of onset without thrombolytic therapy were included.The National Institutes of Health Stroke Scale(NIHSS) motor item score increase ≥2 points of the base line within 7 d after stroke onset served as the PMD diagnostic criteria.The differences in clinical and laboratory data,and infarction location were compared between the PMD group and non-PMD group.The multivariate Logistic regression analysis predicted the risk factors of PMD occurrence.Results A total 121 patients with MCA acute cerebral infarction were included in the study and divided into the PMD group (45 cases) and non-PMD group (76 cases).The internal watershed infarction occurrencerate in the PMD group was higher than that in the non-PMD group (26.7 ％ vs.5.3％,p=0.001).The occurrence rate of penetrating arterial infarction (PAI) had no statistical difference between the PMD group and non-PMD group(42.2％ vs.35.5％,P=0.463).PAI was further divided into perforating branch atheromatous disease (BAD) and lipohyalinitic degeneration (LD).The occurrence rate of BAD in the PMD group was significantly higher than that in the non-PMD group (28.9％ vs.9.2％,P=0.005).The stepwise Logistic regression analysis indicated that watershed infarction [odds ratio (OR):9.750,95 ％ confidence interval(CI):2.828-33.612,P=0.000] and BAD lesion (OR:6.036,95 ％ CI:2.119-17.190,P =0.001) were the independent risk factors contributing to PMD.Conclusion Internal watershed infarction and BAD lesion may predict the PMD occurrence.The infarct location is conducive to find the high risk population of cerebral infarction progress.

The relationship between progressive motor deficits and lesion location in patients with single infarction in the lenticulostriate artery territory.

As the corticospinal tracts cross the lenticulostriate artery (LSA) territory at the posterior segment, we hypothesized that posteriorly located infarctions of the LSA may be associated with progressive motor deficits. We prospectively studied 519 consecutive patients with LSA infarctions who entered our hospital within 24 h after onset. We categorized patients into two groups in terms of progress: no progress and progress. Progress was defined as worsening by 1 point or more in the National Institutes of Health Stroke Scale (NIHSS), some of which recovered afterward or thoroughly progressed. LSA infarctions on the first DWI were divided into proximal type and distal (group 1) type. The proximal type was further divided into anterior (group 2), intermediate (group 3) and posterior (group 4) type according to the middle point of antero-posterior diameter of the lateral ventricle. There were 109 patients who showed progress that accounted for 21.0% of all patients. The number of patients who progressed is as follows: distal type 65 (23.8%), anterior type 31 (36.0%), intermediate type 26 (56.5%) and posterior type 97 (85.0%). The Cochran-Armitage test showed a significant increase through group 1 to group 4 (p < 0.0001). Independent predictive factors for progress were male (OR 0.57, p = 0.0107), higher NIHSS on admission (≥4) (OR 3.02, p < 0.0001), intermediate proximal type (OR 3.3, p = 0.0007) and posterior proximal type (OR 16.4, p < 0.0001). The more posterior the infarct location, the more frequent was the progress that occurred, probably due to the anatomical fact that corticospinal tracts crossed the LSA territory at the posterosuperior quadrant.

What drives progressive motor deficits in patients with acute pontine infarction?

Progressive motor deficits are relatively common in acute pontine infarction and frequently associated with increased functional disability. However, the factors that affect the progression of clinical motor weakness are largely unknown. Previous studies have suggested that pontine infarctions are caused mainly by basilar artery stenosis and penetrating artery disease. Recently, lower pons lesions in patients with acute pontine infarctions have been reported to be related to progressive motor deficits, and ensuing that damage to the corticospinal tracts may be responsible for the worsening of neurological symptoms. Here, we review studies on motor weakness progression in pontine infarction and discuss the mechanisms that may underlie the neurologic worsening.

Study on clinical characteristics and prognosis on 44 patients with penetrating artery disease type ischemic stroke / 中国神经精神疾病杂志

Objective To investigate the imaging characteristics, clinical features and outcomes of penetrating ar-tery disease (PAD) cerebral infarction. Methods One hundred cases of cerebral infarction were divided into 44 cases of PAD group and 56 cases of LAA (large artery atherosclerosis ) group by brain MRI and neck CTA, or DSA neck artery ultrasound. The clinical features, imaging characteristics, outcome and progressive motor deficits(PMD) were compared between PAD cerebral infarction and large artery atherosclerosis (LAA) cerebral infarction. Results There were For-ty-four (44%) cases of PAD cerebral infarction, 56 (56%) cases of LAA cerebral infarction according to 2011 Chinese ischemic stroke subclassification (CISS). The smoking, drinking and TIA histories was significantly less in PAD group (27.27%) than in LAA group (50%) (P=0.021,0.023 and 0.025 respectively,);compared with LAA group, PMD occured in PAD group more frequently. (56.82% vs. 30.36%, P=0.008); lesions were located in the lateral ventricles in most PAD group which was significantly different from LAA group (52.27% vs. 21.43%, P=0.001). Modified Rankin Scale, (mRS) was not significantly different between two groups (1.43 ± 1.17 vs. 1.43 ± 1.45, P=0.99) at 3 months. Conclu-sions Patients with PAD cerebral infarction have PMD at early stage but have good prognosis at three months.