Early Magnetic Resonance Imaging Predicts Early Neurological Deterioration in Acute Middle Cerebral Artery Minor Stroke

Dezhi Liu; Wen Sun; Fabien Scalzo; Yunyun Xiong; Xiaohao Zhang; Zhongming Qiu; Wusheng Zhu; Minmin Ma; Wenhua Liu; Gelin Xu; Guangming Lu; David S Liebeskind; Xinfeng Liu

doi:10.1016/j.jstrokecerebrovasdis.2015.10.021

Early Magnetic Resonance Imaging Predicts Early Neurological Deterioration in Acute Middle Cerebral Artery Minor Stroke

J Stroke Cerebrovasc Dis. 2016 Feb;25(2):469-74. doi: 10.1016/j.jstrokecerebrovasdis.2015.10.021. Epub 2015 Nov 30.

Authors

Affiliations

¹ Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China; Neurovascular Imaging Research Core, Department of Neurology, University of California, Los Angeles, Los Angeles, California.
² Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
³ Neurovascular Imaging Research Core, Department of Neurology, University of California, Los Angeles, Los Angeles, California.
⁴ Department of Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
⁵ Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China. Electronic address: xfliu2@vip.163.com.

PMID: 26654665
DOI: 10.1016/j.jstrokecerebrovasdis.2015.10.021

Abstract

Background: Early neurological deterioration (END) is an important factor associated with worse clinical outcome in minor strokes. Early magnetic resonance imaging (MRI) findings can provide better sensitivity to delineate stroke pathophysiology and have diagnostic value associated with causative mechanisms. The aim of this study was to investigate the relationship between early MRI finding and the presence of END in minor stroke patients with lesions in the middle cerebral artery (MCA) territory.

Methods: Consecutive MCA minor stroke patients who were admitted to our center within 24 hours of symptom onset were included in this study. All patients underwent MRI within 24 hours of admission. We analyzed baseline characteristics, infarction patterns, and treatment algorithms. The correlation between early MRI findings and END, defined as National Institutes of Health Stroke Scale score increasing more than 2 points during 72 hours after admission, was also determined.

Results: Across 211 patients meeting entry criteria between January 2010 and December 2013, internal border-zone (IBZ) infarcts on early MRI scan were observed in 23 of 65 patients with END (35.4%) and in 18 of 146 patients without END (12.3%, P < .001). Patients with IBZ infarcts were found to have more hyperlipidemia, less perforating artery infarcts, more pial artery infarcts, more cortical border-zone infarcts and more ipsilateral large arterial stenosis. Logistic regression analysis revealed that IBZ infarct was independently associated with END after adjustment for other factors (odds ratio, 2.50; 95% confidence interval, 1.09-5.74; P = .031).

Conclusions: Early MRI patterns of IBZ infarction are associated with END in minor stroke patients with acute infarcts of the MCA territory.

Keywords: Stroke prognosis; clinical outcome; early neurological deterioration; infarct pattern; magnetic resonance imaging; neuroimaging of acute stroke; outcome predictive factors.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Disease Progression
Female
Humans
Infarction, Middle Cerebral Artery / pathology*
Magnetic Resonance Imaging
Male
Middle Aged
Prognosis
Severity of Illness Index
Stroke / pathology*
Time Factors