title: Distal single subcortical infarction had a better clinical outcome compared with proximal single subcortical infarction.
abstract: OBJECTIVE
  Single subcortical infarction (SSI) may be classified as proximal SSI (pSSI) or distal SSI (dSSI) according to its location within the middle cerebral artery territory. Few studies have examined the differences in clinical outcome between the two. Our study investigated such differences in patients with pSSI or dSSI and examined their baseline characteristics and indicators for small-vessel disease.
  
  
  METHODS
  We prospectively enrolled 400 patients with SSI (208 pSSI and 192 dSSI) who had no middle cerebral artery disease on MR angiography. Data compared included clinical information, lesion size, prevalence of lacune and leukoaraiosis at baseline, National Institutes of Health Stroke Scale score and modified Rankin Scale score at discharge, and any deterioration during admission or recurrence of ischemic stroke <1 year.
  
  
  RESULTS
  In multivariable logistic regression analysis, dSSI was independently associated with patient's history of stroke, admission National Institutes of Health Stroke Scale score ≤3, Fazekas score ≥3, presence of lacune, but not hyperlipidemia. Patients with dSSI had shorter length of hospital stay, lower rate of functional dependence at discharge (modified Rankin Scale score ≥2), and lower deterioration or recurrence risk of ischemic stroke in 1 year. Multivariable logistic regression analysis showed that factors associated with higher deterioration or recurrence risk of ischemic stroke at 1 year included female sex, history of coronary heart disease, pSSI, and not on antithrombotics <48 hours of admission.
  
  
  CONCLUSIONS
  Compared with pSSI, patients with dSSI likely had small-vessel diseases but better clinical outcome.
authors: From the Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China (C.Z., Yilong Wang, X. Zhao, L.L., C.W., Y.P., X. Zou, W.D., J.J., Y.P., Yongjun Wang); INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (K.S.W.).
authors: Changqing
authors: C
authors: Zhang
authors: From the Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China (C.Z., Yilong Wang, X. Zhao, L.L., C.W., Y.P., X. Zou, W.D., J.J., Y.P., Yongjun Wang); INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (K.S.W.).
authors: Yilong
authors: Y
authors: Wang
authors: From the Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China (C.Z., Yilong Wang, X. Zhao, L.L., C.W., Y.P., X. Zou, W.D., J.J., Y.P., Yongjun Wang); INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (K.S.W.).
authors: Xingquan
authors: X
authors: Zhao
authors: From the Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China (C.Z., Yilong Wang, X. Zhao, L.L., C.W., Y.P., X. Zou, W.D., J.J., Y.P., Yongjun Wang); INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (K.S.W.).
authors: David
authors: D
authors: Wang
authors: From the Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China (C.Z., Yilong Wang, X. Zhao, L.L., C.W., Y.P., X. Zou, W.D., J.J., Y.P., Yongjun Wang); INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (K.S.W.).
authors: Liping
authors: L
authors: Liu
authors: From the Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China (C.Z., Yilong Wang, X. Zhao, L.L., C.W., Y.P., X. Zou, W.D., J.J., Y.P., Yongjun Wang); INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (K.S.W.).
authors: Chunxue
authors: C
authors: Wang
authors: From the Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China (C.Z., Yilong Wang, X. Zhao, L.L., C.W., Y.P., X. Zou, W.D., J.J., Y.P., Yongjun Wang); INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (K.S.W.).
authors: Yuehua
authors: Y
authors: Pu
authors: From the Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China (C.Z., Yilong Wang, X. Zhao, L.L., C.W., Y.P., X. Zou, W.D., J.J., Y.P., Yongjun Wang); INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (K.S.W.).
authors: Xinying
authors: X
authors: Zou
authors: From the Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China (C.Z., Yilong Wang, X. Zhao, L.L., C.W., Y.P., X. Zou, W.D., J.J., Y.P., Yongjun Wang); INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (K.S.W.).
authors: Wanliang
authors: W
authors: Du
authors: From the Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China (C.Z., Yilong Wang, X. Zhao, L.L., C.W., Y.P., X. Zou, W.D., J.J., Y.P., Yongjun Wang); INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (K.S.W.).
authors: Jing
authors: J
authors: Jing
authors: From the Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China (C.Z., Yilong Wang, X. Zhao, L.L., C.W., Y.P., X. Zou, W.D., J.J., Y.P., Yongjun Wang); INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (K.S.W.).
authors: Yuesong
authors: Y
authors: Pan
authors: From the Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China (C.Z., Yilong Wang, X. Zhao, L.L., C.W., Y.P., X. Zou, W.D., J.J., Y.P., Yongjun Wang); INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (K.S.W.).
authors: Ka Sing
authors: KS
authors: Wong
authors: From the Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China (C.Z., Yilong Wang, X. Zhao, L.L., C.W., Y.P., X. Zou, W.D., J.J., Y.P., Yongjun Wang); INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); and Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (K.S.W.). yongjunwang1962@gmail.com.
authors: Yongjun
authors: Y
authors: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002544:Cerebral Infarction / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000401:mortality / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012044:Regression Analysis; D012307:Risk Factors; D020521:Stroke / Q000401:mortality / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult
keywords: cerebral small vessel diseases; stroke, infarct; stroke, lacunar