title: Pathogenic Heterogeneity of Distal Single Small Subcortical Lenticulostriate Infarctions Based on Lesion Size.
abstract: BACKGROUND
  Single small subcortical infarctions (SSSIs) in the lenticulostriate artery territory can be classified as proximal single small subcortical infarction (pSSSI) or distal single small subcortical infarction (dSSSI) lesions depending on the involvement of the lowest part of the basal ganglia. It was reported that pSSSI lesions have more characteristics of large artery atherosclerosis, whereas dSSSI lesions are more characteristic of small vessel disease. Because infarction of small vessels is more likely to be distal and may result in small lesions, we hypothesized that the clinical features of dSSSI lesions might be heterogeneous and classified based on lesion size.
  
  
  METHODS
  Lenticulostriate SSSI patients admitted within 72 hours of stroke onset were included from a prospectively registered hospital-based stroke database. We determined the location (lowest slice [LS] involved) and size (total number of slices [TNS] involved) of SSSIs on magnetic resonance imagings. Based on lesion location, SSSIs were divided into pSSSI (LS ≤ 2) and dSSSI (LS > 2); the latter were further subdivided into distal and small SSSI (ds-SSSI, TNS ≤ 2) or distal and large SSSI (dl-SSSI, TNS > 2). The clinical characteristics were compared between different groups.
  
  
  RESULTS
  A total of 204 patients were included out of 1158 patients registered in the database. We found that ds-SSSI was most often associated with severe white matter hyperintensities. However, patients with dl-SSSI most often had a higher rate of additional concurrent atherosclerotic disease as coronary heart disease, compared to patients with ds-SSSI.
  
  
  CONCLUSIONS
  The pathogenesis of dSSSI may be heterogeneous depending on lesion size.
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Song
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
authors.forename: Quan
authors.initials: Q
authors.lastname: Yong
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
authors.forename: Lu
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Ji
authors.affiliation: Department of Neurology, Huashan Hospital, State Key Laboratory of Neurobiology, Fudan University, Shanghai, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Dong
authors.affiliation: INI Stroke Network, OSF Healthcare System, Department of Neurology, University of Illinois College of Medicine, Peoria, Illinois.
authors.forename: David Z
authors.initials: DZ
authors.lastname: Wang
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China. Electronic address: xuyuming@zzu.edu.cn.
authors.forename: Yuming
authors.initials: Y
authors.lastname: Xu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology; D002536:Cerebral Arteries / Q000473:pathology; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000453:epidemiology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D020244:Infarction, Middle Cerebral Artery / Q000097:blood / Q000145:classification / Q000453:epidemiology / Q000473:pathology*; D002537:Intracranial Arteriosclerosis / Q000097:blood / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D066127:White Matter / Q000473:pathology; D055815:Young Adult
keywords: Single small subcortical infarction; atherosclerosis; lesion pattern; parent artery disease; small vessel disease