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The relationship between neurological worsening and lesion patterns in patients with acute middle cerebral artery stenosis.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Tamura, Aiko Yamamoto, Yasumasa Nagakane, Yoshinari Takezawa, Hidesato Koizumi, Takashi Makita, Naoki Makino, Masahiro
Description	Country affiliation: Japan Author Affiliation: Tamura A ( Department of Neurology, Kyoto Second Red Cross Hospital, Kyoto, Japan.)
Abstract	BACKGROUND: Intracranial atherosclerotic disease is one of the most common causes of ischemic stroke especially in Asians, Hispanics and blacks. Although middle cerebral artery (MCA) stenosis is increasingly being recognized with the advent of magnetic resonance angiography (MRA) or transcranial Doppler ultrasonography, few studies have focused on acute neurological worsening (NW) in patients with MCA stenosis. We investigated the relationship between NW and lesion patterns detected by diffusion-weighted imaging (DWI). METHODS: We studied 44 consecutive patients out of a total of 2,863 consecutive patients who had symptomatic lesions in the territory of the MCA and in whom MRA and/or conventional angiography showed isolated MCA stenosis ≥50% in the MCA trunk. Acute DWI lesion patterns were classified as follows: (1) pial artery territory infarcts (PAI); (2) small cortical and/or subcortical infarcts (SCS); (3) deep penetrating artery territory infarcts (DPI); (4) cortical border zone infarcts (CBZ), and (5) internal border zone infarcts (IBZ). NW was defined as worsening by ≥2 points on the National Institutes of Health Stroke Scale (NIHSS) during the first 7 days. Functional outcome was assessed by the modified Rankin Scale (mRS) at 3 months after stroke onset. Poor outcome was defined as ≥3 on the mRS. The severity of MCA stenosis on MRA was further categorized as 50-75% (moderate) and >75% or focal signal loss with the presence of distal MCA signal (severe). RESULTS: There were 14 patients (31.8%) who showed NW and 16 patients (36.3%) who showed poor outcomes. Nine of the 14 patients with NW showed poor outcomes (64.2%). The most frequent lesions in the present study were SCS (n = 16, 36.3%), followed by IBZ (n = 12, 27.2%) and DPI (n = 11, 25.0%). Prevalence of IBZ was significantly higher in the group with NW compared to that without NW (p = 0.0081), while the prevalence of SCS, DPI, PAI and CBZ did not differ between the two groups. Logistic regression analysis showed significantly high age- and sex-adjusted odds ratios (ORs) for NW only for IBZ (OR 10.9, p = 0.0051). The degree of stenosis did not correlate with NW and lesion patterns. CONCLUSIONS: Only IBZ among various lesion patterns correlated strongly with NW. IBZ are considered to be more associated with hemodynamic compromise, while embolic pathogeneses contribute more to CBZ or SCS. Early interventional medical treatments such as thrombolytic or anti-platelet therapy or stenting should be considered in cases of IBZ in MCA stenosis.
File Format	HTM / HTML
ISSN	10159770
e-ISSN	14219786
Journal	Cerebrovascular Diseases
Issue Number	3
Volume Number	35
Language	English
Publisher	Karger
Publisher Date	2013-01-01
Publisher Place	Switzerland
Access Restriction	Open
Subject Keyword	Discipline Vascular Diseases Discipline Cardiology Constriction, Pathologic Pathology Middle Cerebral Artery Brain Ischemia Physiopathology Diffusion Magnetic Resonance Imaging Infarction, Middle Cerebral Artery Magnetic Resonance Angiography Stroke Ultrasonography, Doppler, Transcranial
Content Type	Text
Resource Type	Article
Subject	Neurology Neurology (clinical) Cardiology and Cardiovascular Medicine

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