title: Hemodynamic factors may play a critical role in neurological deterioration occurring within 72 hrs after lacunar stroke.
abstract: BACKGROUND
  Whether a perfusion defect exists in lacunar infarct and whether it is related to early neurological deterioration (END) is still under debate. The aim of this study was to evaluate whether END in lacunar infarct is related to a perfusion defect using diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI) and perfusion MR imaging.
  
  
  METHODS
  One hundred and forty-one consecutive patients had an MRI scan within 30 hours after onset of symptoms and 43 patients with acute lacunar infarct and classic lacunar syndrome were recruited. The MRI sequences included DWI, DTI and cerebral blood flow (CBF) maps to respectively represent the topographic locations of acute infarcts, the corticospinal tract and perfusion defects. The END was defined in reference to the National Institute of Health Stroke Scale (NIHSS) as an increase ≧2 within 72 hours. Cohen's Kappa coefficient was used to examine the reliability between the 2 image readers. A multivariate logistic regression model was constructed adjusting for baseline variables.
  
  
  RESULTS
  Ten out of the 43 patients had END. Patients having END was significantly associated with lower chances of favorable and good outcomes at 3 months (p = 0.01 and p = 0.002, respectively). END was predicted when the non-core hypoperfused area overlapped on the corticospinal tract, which is defined as the expected END profile. Cohen's Kappa coefficient between the 2 image readers to define images of expected END profiles was 0.74. In 15 patients with expected END profile, 9 had END clinically, whereas 28 patients had no expected END profile, and only 1 patient had END (p<0.0001). After adjusting for sex, the expected END profile was still associated with END (odds ratio, 42.2; p = 0.002).
  
  
  CONCLUSIONS
  Our study demonstrated that the END in acute lacunar stroke is likely related to the transformation of non-core hypoperfused area into infarction in the anatomy of corticospinal tracts.
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan.
authors.forename: Yen-Chu
authors.initials: YC
authors.lastname: Huang
authors.affiliation: Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi,Taiwan.
authors.forename: Yuan-Hsiung
authors.initials: YH
authors.lastname: Tsai
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan.
authors.forename: Jiann-Der
authors.initials: JD
authors.lastname: Lee
authors.affiliation: Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi,Taiwan.
authors.forename: Hsu-Huei
authors.initials: HH
authors.lastname: Weng
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan.
authors.forename: Leng-Chieh
authors.initials: LC
authors.lastname: Lin
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan.
authors.forename: Ya-Hui
authors.initials: YH
authors.lastname: Lin
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan.
authors.forename: Chih-Ying
authors.initials: CY
authors.lastname: Wu
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan.
authors.forename: Ying-Chih
authors.initials: YC
authors.lastname: Huang
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan.
authors.forename: Huan-Lin
authors.initials: HL
authors.lastname: Hsu
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan.
authors.forename: Meng
authors.initials: M
authors.lastname: Lee
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan.
authors.forename: Hsin-Ta
authors.initials: HT
authors.lastname: Yang
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan.
authors.forename: Chia-Yu
authors.initials: CY
authors.lastname: Hsu
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan.
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Pan
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan.
authors.forename: Jen-Tsung
authors.initials: JT
authors.lastname: Yang
mesh_terms: D000368:Aged; D002560:Cerebrovascular Circulation; D003710:Demography; D038524:Diffusion Magnetic Resonance Imaging; D056324:Diffusion Tensor Imaging; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D059409:Stroke, Lacunar / Q000503:physiopathology*; D013997:Time Factors