title: Intracranial atherosclerosis is associated with progression of neurological deficit in subcortical stroke.
abstract: BACKGROUND
  Progression of neurological deficit (PND) is a frequent complication of acute subcortical ischemic stroke (SCS). The role of intracranial atherosclerosis (IAS) in PND is controversial. Our goal was to evaluate IAS on admission, as predictor of PND in SCS patients.
  
  
  METHODS
  SCS patients were identified from our prospective database from 2004 to 2008. Clinical and laboratory data were collected from charts, and radiographic data from original radiographs. The proximal intracranial arteries were graded as patent, irregular, stenotic, or occlusion. IAS was defined as irregularity or stenosis. PND was defined as a change in the National Institutes of Health Stroke Scale >1 point.
  
  
  RESULTS
  Two hundred and two SCS patients were identified. In 14%, PND occurred at a median of 2 days from onset. Univariate analysis by infarct location showed the following to be associated with PND: for anterior circulation infarcts (centrum semiovale/basal ganglia), M1 atherosclerosis (p = 0.042); for posterior circulation infarcts, vertebral artery atherosclerosis (p = 0.018). For both groups, we found a non-significant association with age (p = 0.2) and HbA1c levels (p = 0.095). No association was found with admission glucose levels. Multivariate analysis showed the following association with PND: for anterior circulation infarcts, M1 atherosclerosis (OR 4.7; 95% CI 1.2-18.8; p = 0.03); for pontine infarcts, vertebral artery atherosclerosis (OR 5.8; 95% CI 1.1-29.4; p = 0.033). There was an increase in PND likelihood with an increasing number of atherosclerotic vessels.
  
  
  CONCLUSIONS
  In our cohort of SCS patients, PND was associated with IAS of the responsible vessels. These results suggest a role for IAS in the pathogenesis of PNF in SCS patients.
authors: Department of Neurology and Stroke Program, Sourasky Medical Center and Tel Aviv University, Tel Aviv, Israel. hen.hallevi@gmail.com
authors: Hen
authors: H
authors: Hallevi
authors: Oleg Y
authors: OY
authors: Chernyshev
authors: Ramy
authors: R
authors: El Khoury
authors: Michael J
authors: MJ
authors: Soileau
authors: Kyle C
authors: KC
authors: Walker
authors: James C
authors: JC
authors: Grotta
authors: Sean I
authors: SI
authors: Savitz
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D002533:Cerebral Angiography / Q000379:methods; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009460:Neurologic Examination; D016017:Odds Ratio; D010343:Patient Admission; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D013781:Texas; D013997:Time Factors; D014057:Tomography, X-Ray Computed