Stroke Subtypes and Topographic Locations Associated with Neurological Deterioration in Acute Isolated Pontine Infarction

Basilar Dolichoarteriopathy and Early Clinical Deterioration in Acute Isolated Pontine Infarction

OBJECTIVES

Early clinical worsening (ECW) in acute isolated pontine infarcts (AIPI) is frequent, associated with poor prognosis, and its predictors have not been adequately clarified. A possible role of dolichoectatic basilar artery (BA) anatomy in ECW in patients with AIPI is herein studied.

METHODS

In 146 AIPI patients, infarcts were grouped into tegmental, lateral, anterolateral, anteromedial horizontally; and low, mid, mid-up, and upper pontine vertically. BA dolichoectasia was categorized according to Smoker criteria. An additional criteria of BA laterality angle was described. The length between the infarct long-axis and BA cross-sectional center was measured, and named as "branch length (BL)." ECW was defined as any increase in NIHSS.

RESULTS

ECW was seen in 22 (15%) patients. Univariate analysis documented a higher female ratio (22% vs. 10%, P =0.007), higher atrial fibrillation (18% vs. 7%, P =0.067), more common anteromedial infarct location (77% vs. 49%, P =0.025), and Smoker category-3 BA height (32% vs. 10%, P =0.043) in these patients. In anteromedial infarcts, BL was longer (8.3 vs. 6.1 mm, P =0.052), and reaching to significance in those located at mid-up/upper pontine level (1.22 vs. 0.62 mm, P =0.006). BL >4.4 mm showed an acceptable discriminatory capacity for ECW with an AUC of ROC: 0.615 (95% CI: 0.511-0.712). A regression model indicated female sex (β±SE=1.129±0.551, P =0.040), BL (per 4.4 mm, β±SE=1.236±0.614, P =0.044), and BA height-category-3 (β±SE=1.711±0.645, P =0.008) as independent predictors for ECW.

CONCLUSIONS

Some features of basilar dolichoarteriopathy, such as the extreme location of the height of the BA tip and the length of the involved perforator in the prepontine cistern, may be predictors of early clinical worsening in acute isolated pontine infarcts.

Intravenous thrombolysis prevents neurological deterioration in patients with acute pontine infarction

Objectives

Neurological deterioration (ND) is common after acute isolated pontine infarction, and no evidence-based treatment is available to prevent this. We determined whether intravenous thrombolysis (IVT) with tissue plasminogen activator soon after pontine infarction prevents ND.

Methods

We retrospectively enrolled consecutive patients admitted to our hospital within 4.5 h after the onset of isolated pontine infarction identified using diffusion-weighted imaging. Patients were divided into the IVT and non-IVT groups. ND was defined as any ≥2-point increase in the National Institutes of Health Stroke Scale (NIHSS) score between the maximal and initial neurological deficits during hospitalization. Patients' clinical characteristics, laboratory findings, and outcomes were analyzed to determine the efficacy and safety of IVT.

Results

Of 211 study patients (median age, 67 years [interquartile range, 57-75 years]; 132 [62.6%] men), 74 received IVT; 137 patients did not receive IVT, but accepted other antithrombotic therapies, including antiplatelet or anticoagulant drugs. The NIHSS score on admission was higher in the IVT group than in the non-IVT group (7 vs. 4, P = 0.000), but that at discharge was similar in both groups (4 vs. 5, P = 0.975). ND occurred in 17 (23.0%) and 51 (37.2%) patients in the IVT and non-IVT groups, respectively (P = 0.044). Multiple logistic regression analysis identified IVT (odds ratio, 1.509; 95% confidence interval, 1.250-3.034) as an independent factor for preventing ND. The incidence of intracranial hemorrhagic transformation (P = 0.351) and major visceral organ hemorrhage (P = 0.122) was similar in both groups.

Conclusions

IVT may prevent early ND after acute pontine infarction without increasing intracranial hemorrhagic transformation, possibly by decreasing the total thrombotic burden.

Predictive Factors of Early Neurologic Deterioration in Isolated Pontine Infarction

BACKGROUND AND OBJECTIVES

Neurologic deterioration frequently occurs during the acute phase of isolated pontine infarction (IPI). However, the factors that predict early neurologic deterioration (END) are not well understood. The purpose of this study is to identify and analyze the predictors of END in individuals with IPI.

METHODS

One hundred and fifty-three patients diagnosed with acute IPI were included in this retrospective study, including 41 individuals in the END group and 112 in the non-END group. Demographic characteristics, clinical data, and imaging features were collected and compared. Logistic regression analysis was used to identify independent predictors of END in patients with IPI, and a receiver operating characteristic (ROC) curve was constructed to assess model performance.

RESULTS

Univariate analysis demonstrated significant differences between the two groups regarding diabetes mellitus, National Institute of Health Stroke Scale (NIHSS) score at admission, etiological classification, and infarct area, with P values less than 0.05. Multivariate binary logistic regression analysis revealed that the NIHSS score at admission and the infarct size were independent predictors of END. The combined ROC analysis of the NIHSS score at admission and the infarct area for predicting END showed a sensitivity of 85.4%, specificity of 83.0%, and an area under the curve of 0.887.

CONCLUSIONS

Basilar artery branch disease is the primary cause of END observed in IPI. Both the NIHSS score at admission and the size of the infarct serve as significant predictors for END in IPI, and the combination of two factors provides value in predicting END and outcomes of IPI patients. Early prediction of END also can guide treatment strategies, aimed at improving patient prognosis.

Hemodynamic characteristics of vertebrobasilar artery fenestration combined with vertebrobasilar dolichoectasia: a study based on magnetic resonance angiography

PURPOSE

This study delves into the hemodynamic characteristics of Vertebrobasilar Artery Fenestration (VBAF) combined with Vertebrobasilar Dolichoectasia (VBD) using Magnetic Resonance Angiography (MRA). By summarizing the hemodynamic features and identifying high-risk populations, we aim to provide insights for clinical treatment.

METHODS

Utilizing MRA images as a foundation, arterial three-dimensional geometric models were constructed. A total of 22 cases were categorized into control, S, L, U, and Spiral groups, and numerical simulation analysis of the vessels was conducted using computational fluid dynamics methods.

RESULTS

Hemodynamic parameters of the VBAF combined with the VBD model were obtained, including blood flow velocity, oscillatory shear stress (OSI), wall shear stress (WSS), and aneurysm formation indicator (AFI). The V, OSI, and WSS indices of the L, U, and Spiral groups were significantly higher than those of the control group (P < 0.05). High-speed blood flow, elevated WSS, and increased OSI in these groups were concentrated at the fenestration site, with scattered distribution along the tortuous vertebral artery and basilar artery segments, accompanied by significant differences in the parameters of the bilateral vertebral arteries.

CONCLUSION

This preliminary investigation identifies the L, U, and Spiral groups as high-risk populations. Abnormal hemodynamics may lead to a vicious cycle in vascular wall pathology, increasing the likelihood of adverse events such as cerebral infarction. Clinical attention should focus on individuals within these groups and their corresponding vascular regions.

MRI-based clinical-radiomics nomogram to predict early neurological deterioration in isolated acute pontine infarction: a two-center study in Northeast China

OBJECTIVE

To predict the appearance of early neurological deterioration (END) among patients with isolated acute pontine infarction (API) based on magnetic resonance imaging (MRI)-derived radiomics of the infarct site.

METHODS

544 patients with isolated API were recruited from two centers and divided into the training set (n = 344) and the verification set (n = 200). In total, 1702 radiomics characteristics were extracted from each patient. A support vector machine algorithm was used to construct a radiomics signature (rad-score). Subsequently, univariate and multivariate logistic regression (LR) analysis was adopted to filter clinical indicators and establish clinical models. Then, based on the LR algorithm, the rad-score and clinical indicators were integrated to construct the clinical-radiomics model, which was compared with other models.

RESULTS

A clinical-radiomics model was established, including the 5 indicators rad-score, age, initial systolic blood pressure, initial National Institute of Health Stroke Scale, and triglyceride. A nomogram was then made based on the model. The nomogram had good predictive accuracy, with an area under the curve (AUC) of 0.966 (95% confidence interval [CI] 0.947-0.985) and 0.920 (95% [CI] 0.873-0.967) in the training and verification sets, respectively. According to the decision curve analysis, the clinical-radiomics model showed better clinical value than the other models. In addition, the calibration curves also showed that the model has excellent consistency.

CONCLUSION

The clinical-radiomics model combined MRI-derived radiomics and clinical metrics and may serve as a scoring tool for early prediction of END among patients with isolated API.

Inhibiting Cyclin B1-treated Pontine Infarction by Suppressing Proliferation of SPP1+ Microglia

Pontine infarction is the major subtype of brainstem stroke causing severe neurological deficits. The pathophysiology and treatment of pontine infarction was rarely studied. A rat model of acute pontine infarction was established via injection of endothelin-1 in the pons. Single-cell RNA sequencing was applied to detect the cellular response in pontine infarction. Based on this finding, a potential treatment for pontine infarction targeting microglia was verified. Occlusion of penetrating artery caused by endothelin-1 led to pontine infarction. Single-cell RNA sequencing revealed a subtype of activated microglia, SPP1+ microglia, which were different from M1-like or M2-like depolarization. SPP1+ microglia interacted with oligodendrocytes and contributed to the demyelination of nerve tracts. Cyclin B1 regulated the proliferation of SPP1+ microglia. Cucurbitacin E, a cyclin B1 inhibitor, reduced the proliferation of SPP1+ microglia around the injured myelin sheath and alleviated the demyelination. Moreover, cucurbitacin E treatment decreased the ischemic infarction volume and neurological deficits after pontine infarction. SPP1+ microglia contributed to axonal demyelination in the pontine infarction, and inhibition of SPP1+ microglia provided neuroprotection for pontine infarction.

Morphological predictors of neurological deterioration in patients with acute isolated pontine infarct

OBJECTIVE

To investigate morphological predictors of neurological deterioration (ND) in patients with acute isolated pontine infarct.

METHODS

Acute isolated pontine infarct patients within 7 days after onset of stroke symptoms were included retrospectively and classified into ND and non-ND groups. Morphological phenotypes (paramedian pontine infarct [PPI], atypical PPI, small deep infarct, and other types), topographical location, and lesion size were evaluated on axial diffusion-weighted imaging.

RESULTS

There were 210 eligible patients, of whom 62 patients had ND (29.5%). The proportion of PPI was significantly higher in ND than that in non-ND (62.9% vs 39.6%). ND occurred more frequently in PPI patients than non-PPI patients (39.8% vs 20.5%). PPI located more frequently in lower pontine (20.4% vs 8.0%) and less in upper pontine (17.3% vs 30.4%, P = 0.028), and had larger ventro-dorsal length (13.8 ± 3.8 vs 9.9 ± 3.1) and width (8.3 ± 2.3 vs 6.2 ± 1.8) than non-PPI patients. The morphological phenotype of PPI was an independent risk factor for ND (OR 4.81, 95%CI 1.54-15.07, P = 0.007) in patients with isolated pontine infarct. The ventro-dorsal length of pontine infarct lesion was associated with ND (OR 1.18, 95%CI 1.01, 1.37, P = 0.034) in PPI patients.

CONCLUSIONS

The morphological phenotype of PPI was a potential predictor for ND in patients with acute isolated pontine infarct. The ventro-dorsal length of pontine infarct lesion was possibly associated with ND in PPI patients.

Serum uric acid to serum creatinine ratio predicts neurological deterioration in branch atheromatous disease

Background and objective

Branch atheromatous disease (BAD) makes patients prone to early neurological deterioration (END), resulting in poor prognosis. The aim of this study was to investigate the association between SUA/SCr and END in BAD stroke patients.

Methods

We conducted a retrospective study that included 241 patients with BAD-stroke within 48 h of symptom onset. We divided the patients into the END group and the no END group. END was defined as an NIHSS score increase of more than 2 points within 1 week. SUA/SCr was calculated by the concentration of serum uric acid and creatine (serum uric acid/serum creatine) on admission. Univariate and multivariate analyses were used to identify independent predictors of END in BAD-stroke patients.

Results

END was observed in 24.1% (58/241) of the patients in our study. Multiple logistic regression analyses showed that SUA/SCr (aOR, 0.716; 95% CI, 0.538-0.952; P = 0.022) and female sex (aOR, 0.469; 95% CI, 0.245-0.898; P = 0.022) were associated with END after adjusting for confounding factors. The predicted value of SUA/Scr for END was a sensitivity of 79.3%, a specificity of 44.8%, and an AUC of 0.609 (95% CI, 0.527-0.691, P < 0.05). The optimal cut-off value was 4.76.

Conclusion

SUA/SCr was negatively associated with the risk of END in BAD stroke patients.

Risk factors for early neurological deterioration in acute isolated pontine infarction without any causative artery stenosis

BACKGROUND

This study aimed to investigate the risk predictors for early neurological deterioration (END) in isolated acute pontine infarction without any causative artery stenosis.

METHODS

In this retrospective study, patients with isolated acute pontine infarction within 72 h of symptom onset were enrolled between October 2017 and December 2021. END was defined as an increase in the National Institutes of Health Stroke Scale (NIHSS) score ≥ 2 points within the first week postadmission. Patients were divided into the END and the non-END groups. Multiple logistic regression analysis was used to evaluate independent predictors of END in patients with isolated acute pontine infarction.

RESULTS

A total of 153 patients were included in the final study (62 females; mean age, 67.27 ± 11.35 years), of whom 28.7% (47 of 153) experienced END. Multiple logistic regression analyses showed that infarct volume (adjusted odds ratio [aOR], 1.003; 95% CI, 1.001-1.005; P = 0.002) and basilar artery branch disease  (aOR, 3.388; 95% CI, 1.102-10.417; P = 0.033) were associated with END. The combined ROC analysis of the infarct volume and basilar artery branch disease for predicting END showed that the sensitivity and specificity were 80.9% and 72.6%, respectively.

CONCLUSION

Basilar artery branch disease and infarct volume were associated with END in acute isolated pontine infarction and may be useful prognostic factors for neurological progression.

Anatomic and MRI bases for pontine infarctions with patients presentation

OBJECTIVES

There are scarce data regarding pontine arteries anatomy, which is the basis for ischemic lesions following their occlusion. The aim of this study was to examine pontine vasculature and its relationships with the radiologic and neurologic features of pontine infarctions.

MATERIALS AND METHODS

Branches of eight basilar arteries and their twigs, including the larger intrapontine branches, were microdissected following an injection of a 10% mixture of India ink and gelatin. Two additional brain stems were prepared for microscopic examination after being stained with luxol fast blue and cresyl violet. Finally, 30 patients with pontine infarctions underwent magnetic resonance imaging (MRI) in order to determine the position and size of the infarctions.

RESULTS

The perforating arteries, which averaged 5.8 in number and 0.39 mm in diameter, gave rise to paramedian and anteromedial branches, and also to anterolateral twigs (62.5%). The longer leptomeningeal and cerebellar arteries occasionally gave off perforating and anterolateral twigs, and either the lateral or posterior branches. Occlusion of some of these vessels resulted in the paramedian (30%), anterolateral (26.7%), lateral (20%), and combined infarctions (23.3%), which were most often isolated and unilateral, and rarely bilateral (10%). They were located in the lower pons (23.3%), middle (10%) or rostral (26.7%), or in two or three portions (40%). Each type of infarction usually produced characteristic neurologic signs. The clinical significance of the anatomic findings was discussed.

CONCLUSIONS

There was a good correlation between the intrapontine vascular territories, the position, size and shape of the infarctions, and the type of neurologic manifestations.

Site and Mechanism of Recurrent Pontine Infarction: A Hospital-Based Follow-Up Study

Although pontine infarction is the most common subtype of posterior circulation stroke, there has been little research focusing on recurrent pontine infarction. Our study aimed to investigate the factors associated with site and mechanism of recurrent pontine infarction. Patients with acute isolated pontine infarction were enrolled and followed up for one year. Lesion topography was determined by diffusion-weighted imaging. Mechanisms were determined based on lesion topography and other vascular, cardiologic and laboratory results. A total of 562 patients with pontine infarction were included, with 67 patients experiencing recurrence during the follow-up period. Forty-one recurrences occurred at the same site as index pontine infarction (41/67, 61.2%). Results indicated that the mechanism of index pontine infarction was significantly associated with the recurrent sites (p = 0.041, OR 2.938, 95% CI 1.044–8.268), and also with the mechanisms of recurrence (p = 0.004, OR 6.056, 95% CI 1.774–20.679). Branch atheromatous disease-induced index pontine infarction was likely to recur at the same site and with the same mechanism. Moreover, if recurrence occurred at the same site, the mechanism was probably the same as that of the index stroke (p = 0.000). Our study may help physicians treat patients with pontine infarction by predicting the site and mechanism of recurrence.

Apparent diffusion coefficient signature of ischemic tissue predicts neurological progression in isolated pontine infarcts

BACKGROUND

Early neurological deterioration is encountered in up to a third of patients with isolated pontine infarcts. A limited number of clinical and imaging features have been suggested as predictors of neurological progression in this setting. In this study, we assessed whether quantitative apparent diffusion coefficient (ADC) measurements within the ischemic pontine region could be used as a radiomic feature to forecast clinical deterioration.

METHODS

We calculated the mean ADC value of ischemic voxels within the ischemic region and normalized them to the contralateral non-ischemic tissue (relative ADC, rADC) in patients with isolated pontine infarcts. This imaging signature was then compared among patients with neurological progression (n = 21) and a propensity matched cohort of non-progressors (n = 42), together with other clinical and imaging features in bivariate and multivariate statistical models.

RESULTS

The rADCmean was significantly lower among patients with progression (p = 0.008). Female gender and extension of the ischemic lesion to the ventral pontine surface were other features significantly associated with progression. The association between rADCmean and progression persisted in multivariate models with an odds ratio of 13.7 (95% CI 2.6-72.8; p = 0.002) for progression among patients with rADCmean ≤ 0.67 in their ischemic tissue. The probability for worsening was 80% among patients who had an ischemic lesion extending to the ventral pontine surface with a mean rADC ≤ 0.67.

CONCLUSION

The mean rADC value within the ischemic lesion is closely related with early neurological deterioration in patients with isolated pontine infarcts.

Higher Prevalence of Diabetes in Pontine Infarction than in Other Posterior Circulation Strokes

BACKGROUND

Pontine infarction is the major subtype of posterior circulation stroke, and diabetes is more common in pontine infarction patients than in anterior circulation stroke patients. Whether the prevalence of diabetes remains homogenous within the posterior circulation stroke population is unclear. The present study is aimed at investigating the prevalence of diabetes in pontine infarction and comparing it to other subtypes of posterior circulation stroke.

METHODS

We conducted a multicenter case-control study. Patients with posterior circulation stroke were screened. The subjects were divided into pontine infarction and nonpontine infarction groups.

RESULTS

From November 1, 2018, to February 28, 2021, a total of 6145 stroke patients were screened and 2627 patients had posterior circulation strokes. After excluding cardioembolic stroke, as well as its other determined and undetermined causes, 1549 patients with 754 pontine infarctions were included in the analysis. The prevalence of diabetes in the pontine infarction group was higher than that in the nonpontine infarction group (42.7% vs. 31.4%, P < 0.05). After adjusting for confounding factors, diabetes was an independent risk factor for pontine infarction (OR 1.63, 95% CI 1.27-2.09, P < 0.05). For small vessel occlusion, diabetes was also more common in the pontine infarction group (43.2% vs. 30.0%, P < 0.05). Multivariate analysis also showed that diabetes was an independent risk factor for pontine infarction (OR 1.80, 95% CI 1.32-2.46, P < 0.05).

CONCLUSION

In comparison with the nonpontine infarction subtype of posterior circulation stroke, patients with pontine infarction had a higher prevalence of diabetes, and diabetes was an independent risk factor for pontine infarction.

Monocyte to High-Density Lipoprotein Ratio Is Associated With Early Neurological Deterioration in Acute Isolated Pontine Infarction

Objectives: The monocyte to high-density lipoprotein ratio (MHR) has been considered to be a novel inflammatory marker of atherosclerotic cardiovascular disease. However, its role in the acute phase of acute isolated pontine infarctions remains elusive. We explored whether an association existed between elevated MHR levels and early neurological deterioration (END) in patients with isolated pontine infarction.

Methods: Data from 212 patients with acute isolated pontine infarction were retrospectively analyzed. We examined the MHR in quartiles of increasing levels to evaluate for possible threshold effects. END was defined as an elevation in the total National Institutes of Health Stroke Scale (NIHSS) score ≥2 or an increase in NIHSS score ≥1 in motor power within the first week after symptom onset. Patients were divided into an END group and a non-END group. The association of MHR on END following pontine infarction was examined by logistic regression models after adjusting for age, NIHSS at admission, basilar artery stenosis, history of hypertension or hyperlipidemia or stroke, infarct size, fasting blood glucose, and paramedian pontine infarction.

Results: The mean MHR was 0.44 ± 0.22. A total of 58 (27.36%) patients were diagnosed with END. END occurred within the first 48 h after hospitalization in 38 patients (65.52%). After adjusting for confounding and risk factors, the multivariate logistic regression analysis showed NIHSS at admission [odds ratio (OR), 1.228; 95% confidence interval (CI), 1.036–1.456], basilar artery stenosis (OR, 2.843; 95% CI, 1.205–6.727), and fasting blood glucose (OR, 1.296; 95% CI, 1.004–1.672) were independently associated with END. The odds ratio of END increased as the quartile level of MHR increased, with the lowest quartile used as the reference value. Compared to the first quartile of MHR, the third and fourth quartiles were associated with 4.847-fold (95% CI, 1.532–15.336) and 5.824-fold (95% CI, 1.845–18.385) higher odds of END in multivariate analysis.

Conclusions: Elevated MHR levels may be valuable as a biomarker of END in patients with isolated pontine infarction. The elevated MHR was independently associated with END in isolated pontine infarction.

Blood Pressure Variability and Severity of Early Prognosis in Patients with Acute Pontine Infarction

Background

Increased blood pressure (BP) variability may worsen the prognosis of stroke. This study aimed at investigating the association between BP variability and early functional prognosis in patients with pontine infarction.

Methods

According to types of pontine infarction, all the 137 patients were divided into two groups: 70 patients with paramedian pontine infarction (PPI) and 67 patients with deep pontine infarction (DPI). Common risk factors, 24-hour continuous blood pressure monitoring data, and the coefficient of variation were collected after admission in the hospital. Functional outcomes were evaluated with modified Rankin scale (mRS) at 3 months after discharge (favorable outcome: mRS scores ≤ 2; poor outcome: mRS scores > 2).

Results

The level of Glu, HbA1c, LDL, and NIHSS scores in the PPI group was significantly higher than that in the DPI group, and the concentration of blood uric acid was lower in the PPI group. Diastolic pressure in the PPI group is significantly higher than that in the DPI group, and coefficient of variation (CV) of systolic pressure in PPI is higher when compared with DPI ((88.77 ± 1.71) mmHg vs. (80.74 ± 1.31) mmHg; (11.54 ± 0.35) vs. (10.24 ± 0.25)). In multivariate analyses, the CV of systolic pressure, diastolic pressure, NIHSS scores, and the paramedian pontine infarction was independently associated with 3-month clinical outcome (OR = 1.94, 95% CI = 1.252–2.994, P=0.003; OR = 1.08, 95% CI = 1.002–1.166, P=0.04; OR = 1.58, 95% CI = 1.164–2.159, P=0.003; OR = 9.87, 95% CI = 1.045–32.193, P=0.04).

Conclusion

In conclusion, increased 24-hour (BP) variability, NIHSS scores, and paramedian pontine were associated with early poor prognosis in patients with acute pontine infarction.

Topographic location of unisolated pontine infarction

BACKGROUND

The topographic location of acute pontine infarction is associated with clinical syndromes and prognosis. Previous studies focused on isolated pontine infarction, but the topographic location of unisolated pontine infarction has remained unclear.

METHODS

This was a prospective, multicenter, longitudinal registry study. Patients with acute pontine infarction confirmed by magnetic resonance imaging (MRI) were enrolled. Based on the territory of the pontine artery, the topographic location was divided into anteromedial, anterolateral, tegmental, bilateral and unilateral multiple infarctions.

RESULTS

From May 1, 2003, to Oct 31, 2017, 1003 patients were enrolled, and 330 had unisolated pontine infarction. For isolated pontine infarction, 44.9, 19.8, 16.0, 13.1 and 6.2% of patients had anteromedial, anterolateral, tegmental, bilateral and unilateral multiple pontine infarctions, respectively. For unisolated pontine infarction, 30.3, 19.7, 24.5, 15.2 and 10.3% of patients had anteromedial, anterolateral, tegmental, bilateral and unilateral multiple pontine infarctions, respectively.

CONCLUSION

In this large series study, our data revealed fewer anteromedial infarctions and more tegmental and unilateral multiple infarctions in patients with unisolated pontine infarction than in patients with isolated pontine infarction.

Progressive deficit in isolated pontine infarction: the association with etiological subtype, lesion topography and outcome

It is important to predict progressive deficit (PD) in isolated pontine infarction, a relatively common problem of clinical stroke practice. Traditionally, lacunar infarctions are known with their progressive course. However, few studies have analyzed the branch atheromatous disease subtype as a subtype of lacunar infarction, separately. There are also conflicting results regarding the relationship with the topography of lesion and PD. In this study, we classified etiological subtypes and lesion topography in isolated pontine infarction and aimed to investigate the association of etiological subtypes, lesion topography and clinical outcome with PD. We analyzed demographics, laboratory parameters, and risk factors of 120 patients having isolated pontine infarction and admitted within 24 h retrospectively. PD was defined as an increase in the National Institutes of Health Stroke scale ≥2 units in 5 days after onset. Patients were classified as following: large artery disease (LAA), basilar artery branch disease (BABD) and small vessel disease (SVD). Upper, middle and lower pontine infarcts were identified longitudinally. Functional outcome at 3 months was determined according to modified Rankin scores. Of 120 patients, 41.7% of the patients were classified as BABD, 30.8% as SVD and 27.5% as LAA. 23 patients (19.2%) exhibited PD. PD was significantly more frequent in patient with BABD (p 0.006). PD was numerically higher in patients with lower pontine infarction. PD was associated with BABD and poor functional outcome. It is important to discriminate the BABD neuroradiologically from other stroke subtypes to predict PD which is associated with poor functional outcome in patients with isolated pontine infarctions.