Risk factors for early neurologic deterioration in single small subcortical infarction without carrier artery stenosis: predictors at the early stage

Abstract

Objectives This study aimed to assess the epidemiological features and explore the potential risk factors for early neurological deterioration (END) in patients with acute single small subcortical infarction (SSSI) who underwent antiplatelet therapy without carotid artery stenosis. Materials & methods Patients with SSSI, as confirmed by cranial magnetic resonance imaging (MRI), who were hospitalized within 48 h after the onset of symptoms were enrolled. END was mainly defined as increment in the National Institutes of Health Stroke Scale (NIHSS) score of ≥ 2 points or any new neurological deficit. Poor functional outcome was defined as modified Rankin Scale (mRS) score of > 2 points at 3-month after the onset. The association of END with multiple indicators was assessed at the early stage of admission using multivariate logistic regression analysis, and adjusted odds ratios (aORs) were calculated. Results A total of 280 patients were enrolled from June 2020 to May 2021, of whom, END occurred in 44 (15.7%) patients (median age, 64 years; 70.5% male), while END occurred during sleep in 28 (63.6%) patients. History of hypertension (aOR: 4.82, p = 0.001), infarction in internal capsule (aOR: 3.35, p = 0.001), and elevated level of low-density lipoprotein cholesterol (LDL-C; aOR: 0.036, p = 0.0016) were significantly associated with the risk of END. Patients with END (aOR: 5.74, p = 0.002), history of diabetes (aOR: 2.61, p = 0.020), and higher NIHSS scores at discharge (per 1-score increase, aOR: 1.29, p = 0.026) were associated with the poor functional outcome at 3-month after the onset. Conclusion Patients with a history of hypertension, infarction in internal capsule or a higher level of LDL-C were found to be at a higher risk of END.

Prediction of early neurologic deterioration in patients with perforating artery territory infarction using machine learning: a retrospective study

“…The infarction location significantly influences functional limitations, clinical progression, and patient outcomes ( 42 ). Previous studies have indicated that infarct locations within the brainstem, corona radiata, and lenticulostriate artery area, including the internal capsule, are associated with an increased risk of END ( 4 , 43 – 45 ). In our study, lesions in the basal ganglia (excluding the internal capsule) and thalamus were identified as predictors of END, with the former located in the lenticulostriate artery area, aligning with previous studies, and the latter showing comparatively favorable outcomes in terms of mortality and permanent motor deficits.…”

“…The etiology of PAI may involve several mechanisms, such as lipohyalinosis, large plaques in the parent artery, and microatheroma ( 3 ). Lipohyalinosis is a vasculopathy that affects cerebral small vessels, leading to a “lacunar infarct” (LI), a major contributor to PAI ( 4 , 5 ). Similarly, large plaques in the parent artery with severe stenosis may result in perforating artery embolisms.…”

Predictive factors for early neurological deterioration after intravenous thrombolysis of single subcortical infarction in the territory of the middle cerebral artery

“…Several studies have revealed predictors of END in SSI, including age, sex (female), diabetes, blood pressure variability, severe and large infarcts, initial NIHSS score, presence of penetrating artery disease, and inflammatory markers (Del Bene et al., 2012 ; Duan, Sun, et al., 2015 ; Jin et al., 2023 ; Kim et al., 2015 ; Serena et al., 2001 ; Terasawa et al., 2008 ; Yamamoto et al., 2010 ; Zhang et al., 2022 ; Zhou et al., 2018 ). Our study on SSI types is consistent with previous studies (Duan, Fu, et al., 2015 ; Duan, Sun, et al., 2015 ).…”