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Acta Neurologica Belgica

Erschienen in:

19.03.2023 | Original article

Morphological predictors of neurological deterioration in patients with acute isolated pontine infarct

verfasst von: Chen Wang, Jianling Ji, Wanting Wang, Yujie Wang

Erschienen in: Acta Neurologica Belgica | Ausgabe 4/2023

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Abstract

Objective

To investigate morphological predictors of neurological deterioration (ND) in patients with acute isolated pontine infarct.

Methods

Acute isolated pontine infarct patients within 7 days after onset of stroke symptoms were included retrospectively and classified into ND and non-ND groups. Morphological phenotypes (paramedian pontine infarct [PPI], atypical PPI, small deep infarct, and other types), topographical location, and lesion size were evaluated on axial diffusion-weighted imaging.

Results

There were 210 eligible patients, of whom 62 patients had ND (29.5%). The proportion of PPI was significantly higher in ND than that in non-ND (62.9% vs 39.6%). ND occurred more frequently in PPI patients than non-PPI patients (39.8% vs 20.5%). PPI located more frequently in lower pontine (20.4% vs 8.0%) and less in upper pontine (17.3% vs 30.4%, P = 0.028), and had larger ventro-dorsal length (13.8 ± 3.8 vs 9.9 ± 3.1) and width (8.3 ± 2.3 vs 6.2 ± 1.8) than non-PPI patients. The morphological phenotype of PPI was an independent risk factor for ND (OR 4.81, 95%CI 1.54–15.07, P = 0.007) in patients with isolated pontine infarct. The ventro-dorsal length of pontine infarct lesion was associated with ND (OR 1.18, 95%CI 1.01, 1.37, P = 0.034) in PPI patients.

Conclusions

The morphological phenotype of PPI was a potential predictor for ND in patients with acute isolated pontine infarct. The ventro-dorsal length of pontine infarct lesion was possibly associated with ND in PPI patients.

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Park TH, Lee JK, Park MS, Park SS, Hong KS, Ryu WS et al (2022) Neurologic deterioration in patients with acute ischemic stroke or transient ischemic attack. Neurology 95:e2178–e2191. https://doi.org/10.1212/WNL.0000000000010603CrossRef

Gökçal E, Niftaliyev E, Baran G, Deniz Ç, Asil T (2017) Progressive deficit in isolated pontine infarction: the association with etiological subtype, lesion topography and outcome. Acta Neurol Belg 117:649–654. https://doi.org/10.1007/s13760-017-0827-2CrossRefPubMed

Nacu A, Bringeland GH, Khanevski A, Thomassen L, Waje-Andreassen U, Naess H (2016) Early neurological worsening in acute ischaemic stroke patients. Acta Neurol Scand 133:25–29. https://doi.org/10.1111/ane.12418CrossRefPubMed

Saia V, Pantoni L (2009) Progressive stroke in pontine infarction. Acta Neurol Scand 120:213–215. https://doi.org/10.1111/j.1600-0404.2009.01161.xCrossRefPubMed

Kataoka S, Hori A, Shirakawa T, Hirose G (1997) Paramedian pontine infarction. Neurological/topographical correlation. Stroke 28:809–815. https://doi.org/10.1161/01.str.28.4.809CrossRefPubMed

Huang R, Zhang X, Chen W, Lin J, Chai Z, Yi X (2016) Stroke subtypes and topographic locations associated with neurological deterioration in acute isolated pontine infarction. J Stroke Cerebrovasc Dis 25:206–213. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.09.019CrossRefPubMed

Oh S, Bang OY, Chung CS, Lee KH, Chang WH, Kim GM (2012) Topographic location of acute pontine infarction is associated with the development of progressive motor deficits. Stroke 43:708–713. https://doi.org/10.1161/STROKEAHA.111.632307CrossRefPubMed

Nakase T, Sasaki M, Ikeda Y, Suzuki A (2014) Progressing small vessel pontine infarction includes different etiologies. Ann Clin Transl Neurol 1:75–79. https://doi.org/10.1002/acn3.25CrossRefPubMed

Aoki J, Iguchi Y, Kimura K, Suzuki A (2010) Diameter of the basilar artery may be associated with neurological deterioration in acute pontine infarction. Eur Neurol 63:221–226. https://doi.org/10.1159/000279619CrossRefPubMed

10.

Li H, Dai Y, Wu H, Luo L, Wei L, Zhou L, Lin Y, Wang Q, Lu Z (2020) Predictors of early neurologic deterioration in acute pontine infarction. Stroke 51:637–640. https://doi.org/10.1161/STROKEAHA.119.027239CrossRefPubMed

11.

Ju Y, Hussain M, Asmaro K, Zhao X, Liu L, Li J, Wang Y (2013) Clinical and imaging characteristics of isolated pontine infarcts: a 1-year follow-up study. Neurol Res 35:498–504. https://doi.org/10.1179/1743132813Y.0000000207CrossRefPubMed

12.

Yamamoto Y, Ohara T, Hamanaka M, Hosomi A, Tamura A, Akiguchi I (2011) Characteristics of intracranial branch atheromatous disease and its association with progressive motor deficits. J Neurol Sci 304:78–82. https://doi.org/10.1016/j.jns.2011.02.006CrossRefPubMed

13.

Wilson LK, Pearce LA, Arauz A, Anderson DC, Tapia J, Bazan C, Benavente OR, Field TS (2016) Morphological classification of penetrating artery pontine infarcts and association with risk factors and prognosis: The SPS3 trial. Int J Stroke 11:412–419. https://doi.org/10.1177/1747493016637366CrossRefPubMed

14.

Bradley WG Jr (1991) MR of the brain stem: a practical approach. Radiology 179:319–332. https://doi.org/10.1148/radiology.179.2.2014270CrossRefPubMed

15.

Kato H, Takeda T, Ohara K, Tei H, Nishizawa E (2015) Rostrocaudal thickness on sagittal diffusion-weighted imaging as a predictor of motor deficits in an acute isolated pontine infarction. J Stroke Cerebrovasc Dis 24:622–628. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.10.012CrossRefPubMed

16.

Wardlaw JM, Smith EE, Biessels GJ, Cordonnier C, Fazekas F, Frayne R et al (2013) Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol 12:822–838. https://doi.org/10.1016/S1474-4422(13)70124-8CrossRefPubMedPubMedCentral

17.

King KS, Peshock RM, Warren MW, Alhilali L, Hulsey K, McColl R, Weiner MF, Ayers C, Whittemore A (2013) Evaluation of a practical visual MRI rating scale of brain white matter hyperintensities for clinicians based on largest lesion size regardless of location. AJNR Am J Neuroradiol 34:797–801. https://doi.org/10.3174/ajnr.A3283CrossRefPubMedPubMedCentral

18.

Kaps M, Klostermann W, Wessel K, Brückmann H (1997) Basilar branch disease presenting with progressive pure motor stroke. Acta Neurol Scand 96:324–327. https://doi.org/10.1111/j.1600-0404.1997.tb00291.xCrossRefPubMed

19.

Kim JS, Lee JH, Im JH, Lee MC (1995) Syndromes of pontine base infarction. A clinical-radiological correlation study. Stroke 26:950–955. https://doi.org/10.1161/01.str.26.6.950CrossRefPubMed

20.

Nishijima Y (1994) Anatomical analysis of the basilar artery and its branches with special reference to the arterial anastomosis, and its course and distribution on the pontine ventral surface. Nihon Ika Daigaku Zasshi 61:529–547. https://doi.org/10.1272/jnms1923.61.529CrossRefPubMed

21.

Caplan LR (1989) Intracranial branch atheromatous disease: a neglected, understudied, and underused concept. Neurology 39:1246–1250. https://doi.org/10.1212/wnl.39.9.1246CrossRefPubMed

22.

Lim SH, Choi H, Kim HT, Kim J, Heo SH, Chang DI, Lee JY, Lee YJ, Kim JY, Kim HY, Kim YS (2015) Basilar plaque on high-resolution MRI predicts progressive motor deficits after pontine infarction. Atherosclerosis 240:278–283. https://doi.org/10.1016/j.atherosclerosis.2015.03.029CrossRefPubMed

23.

Kim JS, Cho KH, Kang DW, Kwon SU, Suh DC (2009) Basilar artery atherosclerotic disease is related to subacute lesion volume increase in pontine base infarction. Acta Neurol Scand 120:88–93. https://doi.org/10.1111/j.1600-0404.2008.01124.xCrossRefPubMed

24.

Ois A, Martinez-Rodriguez JE, Munteis E, Gomis M, RodriguezCampello A, Jimenez-Conde J, Cuadrado-Godia E (2008) Roquer J (2008) Steno-occlusive arterial disease and early neurological deterioration in acute ischemic stroke. Cerebrovasc Dis 25:151–156. https://doi.org/10.1159/000113732CrossRefPubMed

25.

Kim JT, Kim HJ, Yoo SH, Park MS, Kwon SU, Cho KH, Kim JS, Kang DW (2010) MRI findings may predict early neurologic deterioration in acute minor stroke or transient ischemic attack due to intracranial atherosclerosis. Eur Neurol 64:95–100. https://doi.org/10.1159/00031513826CrossRefPubMed

26.

Kim JS, Yoon Y (2013) Single subcortical infarction associated with parental arterial disease: important yet neglected sub-type of atherothrombotic stroke. Int J Stroke 8:197–203. https://doi.org/10.1111/j.1747-4949.2012.00816.xCrossRefPubMed

27.

Chinese Society of Neurology, Chinese Stroke Society (2015) Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack 2014. Chin J Neurol 48:258–273. https://doi.org/10.3760/cma.j.issn.1006-7876.2015.04.003CrossRef

28.

Kumral E, Bayülkem G, Evyapan D (2002) Clinical spectrum of pontine infarction. Clinical-MRI correlations J Neurol 249:1659–1670. https://doi.org/10.1007/s00415-002-0879-xCrossRefPubMed

29.

Ha SH, Ryu JC, Bae JH, Kim J (2022) Isolated pontine infarction versus pontine plus infarction: prevalence, pathogenic mechanism, and outcomes. J Neurol 269:4375–4382. https://doi.org/10.1007/s00415-022-11075-1CrossRefPubMed

30.

Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D, Investigators ECASS (2008) Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 359:1317–1329. https://doi.org/10.1056/NEJMoa0804656CrossRefPubMed

31.

Vynckier J, Maamari B, Grunder L, Goeldlin MB, Meinel TR, Kaesmacher J et al (2021) Early neurologic deterioration in lacunar stroke: clinical and imaging predictors and association with long-term outcome. Neurology 97:e1437–e1446. https://doi.org/10.1212/WNL.0000000000012661CrossRef

32.

Zhou Z, Delcourt C, Xia C, Yoshimura S, Carcel C, Torii-Yoshimura T et al (2021) Low-dose vs standard-dose alteplase in acute lacunar ischemic stroke: the ENCHANTED trial. Neurology 96:e1512–e1526. https://doi.org/10.1212/WNL.0000000000011598CrossRefPubMedPubMedCentral

33.

Liu Y, Peng H, Wang J, He L, Xu J, Zheng M, Xu Y, Xu F (2022) Risk factors for early neurological deterioration in acute isolated pontine infarction without any causative artery stenosis. BMC Neurol 22:332. https://doi.org/10.1186/s12883-022-02861-5CrossRefPubMedPubMedCentral

Titel: Morphological predictors of neurological deterioration in patients with acute isolated pontine infarct
verfasst von: Chen Wang
Jianling Ji
Wanting Wang
Yujie Wang
Publikationsdatum: 19.03.2023
Verlag: Springer International Publishing
Erschienen in: Acta Neurologica Belgica / Ausgabe 4/2023
Print ISSN: 0300-9009
Elektronische ISSN: 2240-2993
DOI: https://doi.org/10.1007/s13760-023-02234-w

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