title: Early neurological deterioration represents recurrent attack in acute small non-lacunar stroke.
abstract: The aim of this study was to identify the frequency and possible pathogenic mechanisms of early neurological deterioration in patients with acute small non-lacunar infarction. We studied 46 patients (35 men, 11 women; age, 70.3+/-10.4 years) with acute small non-lacunar infarction. Small non-lacunar infarction was diagnosed using diffusion-weighted magnetic resonance imaging (DWI) as being <15 mm in diameter and located in the cortex and centrum ovale in the middle cerebral artery territory. The patients were divided into two groups; Group D (n=6) had neurological deterioration within 7 days after symptom onset, while Group N (n=40) did not have any neurological deterioration. In Group D, the interval from symptom onset to clinical deterioration was 3.3+/-1.5 days (range 2-6 days). Blood pressure on admission was higher in Group D than in Group N (p<0.05). In Group D, four of these five patients with follow-up DWI had new acute small ischemic lesions in addition to the initial lesions, indicating recurrent attacks of brain infarction. Neurological deterioration occurred within 7 days after symptom onset in 13% of patients. Neurological deterioration was frequently caused by recurrent infarction detected by DWI.
authors.affiliation: Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, 565-8565, Osaka, Japan. norip-matsumoto@fc.kuh.kumamoto-u.ac.jp
authors.forename: Noriko
authors.initials: N
authors.lastname: Matsumoto
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
authors.forename: Chiaki
authors.initials: C
authors.lastname: Yokota
authors.forename: Kiminobu
authors.initials: K
authors.lastname: Yonemura
authors.forename: Kuniyasu
authors.initials: K
authors.lastname: Wada
authors.forename: Makoto
authors.initials: M
authors.lastname: Uchino
authors.forename: Kazuo
authors.initials: K
authors.lastname: Minematsu
mesh_terms: D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000473:pathology / Q000503:physiopathology; D002540:Cerebral Cortex / Q000473:pathology / Q000503:physiopathology*; D002544:Cerebral Infarction / Q000473:pathology / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology; D012008:Recurrence; D020521:Stroke / Q000473:pathology / Q000503:physiopathology*