Purpose: Early neurological deterioration (END) in the acute phase of penetrating artery infarction is not uncommon. Recently, atherosclerotic status has been reported to contribute to END. Considering such findings, we further explored factors associated with END in patients with single infarctions in the lenticulostriate artery territory (LSA).
Methods: We studied 523 consecutive patients with LSA who entered our hospital within 24 hours after onset. We categorized subjects into 3 groups: no END, minor END and major END. Minor END was defined as worsening or fluctuation by 1-2 points in the National Institutes of Health Stroke Scale (NIHSS) but recovered afterward. Major END was worsening by 2 or more points in the NIHSS and afterwards thoroughly progressed. LSA infarcts on the first DWI were divided into proximal and distal types. The proximal type was further divided into anterior and posterior type based on the intermediate point in the corona radiating adjacent to the lateral ventricle. Systolic blood pressures in an emergency room (SBP) were categorized into 5 groups as follows: G1; < 140mmHg, G2; 140-159, G3; 160-179; G4; 180-200 and G5; > 200. NIHSS on admission was dichotomized and higher NIHSS was defined as ≥4. Atherosclerotic diseases of the intracranial middle cerebral artery were assessed on MRA as follows: normal, mild stenosis (< 50%) and severe stenosis (> 50%). Central values of modified Rankin scale one month after ictus in 3 END groups were no END (n=302): 1, minor END (n=112): 1 and major END (n=109): 4, respectively. We then calculated the odds ratios (OR) of predictive factors for major END.
Results: Predictive factors found significant by uni-variate analysis were female, anterior and posterior proximal type, mild stenosis, higher NIHSS and G4 and G5 of SBP. Multivariate analysis revealed that anterior proximal type (OR and 95% p< 0.0001), posterior proximal type (156.1, p< 0.0001), mild stenosis (3.0, p=0.014) and higher NIHSS (4.3, p=0.0002) were found to be independently associated with major END.
Conclusions: Posterior rather than anterior proximal type was strongly associated with major END probably due to the anatomical fact that corticospinal tracts crossed the LSA territory at the postero-superior quadrant.