title: Predictors of neurologic deterioration in patients with small-vessel occlusion and infarcts in the territory of perforating arteries.
abstract: BACKGROUND
  It is difficult to predict neurologic deterioration in patients with small-vessel occlusion (SVO), that is, small infarcts in the territory of cerebral perforating arteries.
  
  
  METHODS
  We reviewed 110 patients with SVO who were admitted to our hospital. We divided them into groups with (n = 32, group 1) and without deterioration (n = 78, group 2) and evaluated their medical records, risk factors, magnetic resonance imaging findings, grade of periventricular hyperintensity (PVH), maximum diameter of the infarct area, and the number of slices showing infarcts on diffusion-weighted images (DWI).
  
  
  RESULTS
  Our study population consisted of 110 patients (71 males and 39 females; mean age 69.2 years): 32 (29%) did and 78 (71%) did not suffer deterioration. By univariate analysis, the age, current smoking, history of stroke, maximum diameter of the infarcted area, number of DWI slices with infarcts, frequency of PVH, and PVH grade based on Fazekas classification differed significantly between the 2 groups. By multivariate analysis, conventional risk factors other than PVH and history of stroke were not associated with neurologic deterioration (PVH grade ≥ 2 versus PVH grade ≤ 1, odds ratio 6.72, P = .006; with stroke versus without stroke, odds ratio .21, P = .049). We also found that higher the PVH grade, the worse the National Institutes of Health Stroke Scale score at the time of discharge.
  
  
  CONCLUSIONS
  PVH and without history of stroke are independently associated with neurologic deterioration in patients with SVO.
authors.affiliation: Department of Clinical Neurosciences, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan. Electronic address: nobyamamoto521129@yahoo.co.jp.
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Yamamoto
authors.affiliation: Department of Clinical Neurosciences, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Terasawa
authors.affiliation: Department of Neurosurgery, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Junichiro
authors.initials: J
authors.lastname: Satomi
authors.affiliation: Department of Clinical Neurosciences, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Waka
authors.initials: W
authors.lastname: Sakai
authors.affiliation: Department of Radiology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Harada
authors.affiliation: Department of Clinical Neurosciences, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Yuishin
authors.initials: Y
authors.lastname: Izumi
authors.affiliation: Department of Neurosurgery, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Nagahiro
authors.affiliation: Department of Clinical Neurosciences, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Ryuji
authors.initials: R
authors.lastname: Kaji
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020520:Brain Infarction / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology*; D002536:Cerebral Arteries / Q000473:pathology*; D002552:Cerebral Ventricles / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D020767:Intracranial Thrombosis / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects
keywords: PVH grade; neurologic deterioration; predictors; small-vessel occlusion