title: Neuroimaging markers for early neurologic deterioration in single small subcortical infarction.
abstract: OBJECTIVE
  Early neurological deterioration (END) occurs in ≥20% of single small subcortical infarctions (SSSIs; axial diameter ≤20 mm in the perforator territories) and deters functional recovery. Both microvasculopathies and atherosclerosis have been proposed to independently contribute to the occurrence of END in SSSI cases. We hypothesized that the occurrence of END in SSSIs differs according to the pathological process.
  
  
  METHODS
  We collected data from 587 patients with SSSI within 48 hours of onset from a prospective stroke registry containing 4961 case records. Independent reviewers, blinded to END information, rated neuroimaging characteristics, including relevant artery stenosis (0% to 50% stenosis of the adjacent arteries on magnetic resonance angiography), branch atheromatous lesions (≥4 consecutive axial cuts or extensions from the basal surface of the pons), white matter hyperintensities, old lacunar infarctions, and cerebral microbleeds.
  
  
  RESULTS
  END occurred in 79 (13.5%) cases, including 6 recurrences, 68 progressions, 1 symptomatic hemorrhagic transformation, 1 others, and 3 unknowns. END increased the National Institutes of Health Stroke Scale score by 2.3±1.4 points. Patients with END showed higher frequencies of modified Rankin Scale scores of 3 to 6 after 3 months compared with patients without END (49% versus 23%). Patients with relevant artery stenosis (adjusted odds ratio, 1.91; 95% confidence interval, 1.13-3.21) and branch atheromatous lesions (adjusted odds ratio, 2.98; 95% confidence interval, 1.80-4.93) had significantly higher odds of exhibiting END. However, such an association was not detected with small vessel disease markers.
  
  
  CONCLUSIONS
  Our analysis indicated a potential contribution of the localized atherosclerotic process to END in SSSIs. Precautionary measures might be used for SSSIs suggestive of atherosclerotic pathologies.
authors: From the Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea (H.-G.J.) and Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea (B.J.K., M.H.Y., M.-K.H., H.-J.B.).
authors: Han-Gil
authors: HG
authors: Jeong
authors: From the Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea (H.-G.J.) and Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea (B.J.K., M.H.Y., M.-K.H., H.-J.B.). Kim.BJ.Stroke@gmail.com.
authors: Beom Joon
authors: BJ
authors: Kim
authors: From the Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea (H.-G.J.) and Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea (B.J.K., M.H.Y., M.-K.H., H.-J.B.).
authors: Mi Hwa
authors: MH
authors: Yang
authors: From the Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea (H.-G.J.) and Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea (B.J.K., M.H.Y., M.-K.H., H.-J.B.).
authors: Moon-Ku
authors: MK
authors: Han
authors: From the Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea (H.-G.J.) and Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea (B.J.K., M.H.Y., M.-K.H., H.-J.B.).
authors: Hee-Joon
authors: HJ
authors: Bae
mesh_terms: D000368:Aged; D001158:Arteries / Q000473:pathology; D002545:Brain Ischemia / Q000473:pathology; D002544:Cerebral Infarction / Q000175:diagnosis* / Q000473:pathology*; D003251:Constriction, Pathologic / Q000175:diagnosis; D048909:Diabetes Complications; D018450:Disease Progression; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D020244:Infarction, Middle Cerebral Artery / Q000473:pathology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D059906:Neuroimaging; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic / Q000503:physiopathology; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000503:physiopathology
keywords: atherosclerosis; early neurologic deterioration; lacunar infarct; single small subcortical infarct; stroke