title: Topographic location of acute pontine infarction is associated with the development of progressive motor deficits.
abstract: OBJECTIVE
  Motor weakness progression is relatively common in acute pontine infarction and frequently associated with increased functional disability. We designed this study to identify the predictors of progression of motor weakness in patients with pontine infarction during the acute phase.
  
  
  METHODS
  We identified consecutive patients with acute ischemic stroke in the pons. Patients were defined as having progressive motor deficits (PMD) if their motor National Institutes of Health Stroke Scale scores increased by ≥1 unit between the maximal and initial neurological deficits. To define the predictors of PMD in patients with a pontine infarct, clinical, laboratory, diffusion-weighted imaging lesion location, and magnetic resonance angiographic variables were investigated.
  
  
  RESULTS
  A total of 190 patients (male:female=112:78, 66.4±10.6) were identified, and 49 (25.8%) patients were diagnosed with progressive motor deficits. Logistic multiple regression analysis identified lesion involvement of the lower pons (odds ratio, 3.768; 95% confidence interval, 1.696-8.371) as an independent risk factor contributing to motor progression. Although 34 patients (17.9%) had significant basilar artery stenosis, there was no relationship between PMD in pontine infarct patients and the presence of basilar artery stenosis. Additionally, female and previous hypertension were associated with PMD (odds ratio, 2.651, 95% confidence interval, 1.211-5.802; odds ratio, 3.051, 95% confidence interval, 1.087-9.673).
  
  
  CONCLUSIONS
  Our results suggest that lower pons lesions may contribute to progressive motor deficits in patients with isolated acute pontine infarction. Infarct topography is therefore a potential prognostic factor of PMD, because the location of the infarct can affect the extent of ischemic degeneration of the corticospinal tract.
authors.affiliation: Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea.
authors.forename: Semi
authors.initials: S
authors.lastname: Oh
authors.forename: Oh Young
authors.initials: OY
authors.lastname: Bang
authors.forename: Chin-Sang
authors.initials: CS
authors.lastname: Chung
authors.forename: Kwang Ho
authors.initials: KH
authors.lastname: Lee
authors.forename: Won Hyuk
authors.initials: WH
authors.lastname: Chang
authors.forename: Gyeong-Moon
authors.initials: GM
authors.lastname: Kim
mesh_terms: D000208:Acute Disease; D000368:Aged; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000150:complications* / Q000453:epidemiology / Q000473:pathology*; D016001:Confidence Intervals; D038524:Diffusion Magnetic Resonance Imaging; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology; D009422:Nervous System Diseases / Q000209:etiology*; D016017:Odds Ratio; D011149:Pons / Q000473:pathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012044:Regression Analysis; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000209:etiology / Q000473:pathology; D014715:Vertebrobasilar Insufficiency / Q000150:complications