The Correlation Analysis Of Early Neurological Deterioration In Isolated Pontine Infarction

Objective:To investigated the predictive factors of early neurological deterioration in isolated pontine infarction,we summarized the clinical and radiologic characteristic.Methods:Consecutive collected 138 patients of isolated pontine infarction,who admitted to hospital within 48 hours from symptom onset were collected。All of patients were confirmed as isolated pontine infarction by Diffusion-Weighted Imaging.They were divided into either a END group or a non-END group according to the clinical the National Institutes of Health Stroke Scale(NIHSS).Early neurological deterioration group(END group)was defined as an increase of≥1point on the motor Institutes of Health StrokeScale(NIHSS)or≥2 points on the total NIHSS score.According to neuroimaging of rostrocaudal DWI,isolated pontine infarction was divided into three types:the upper,the middle and lower one.According to the distribution of isolated pontine infarction,we divided into the pontine ventral surface and pontine interior infarction.Basilar artery stenosis was defined as a reduction in the caliber of the basilar artery by at least 50% or occlusion of the basilar artery.According to the potential causes of pontine infarction,we divided into Large artery occlusive desease,Basilar artery branch disease and Small-artery disease.According to the position of white matter hyperintensity,we divided into periventricular white matter hyperintensity and subcortical white matter hyperintensity.We gradedWMH using Fazekas scale,which is dichotomized into mild(grades 0–1)and moderate to severe(grades 2–3)on fluidattenuated inversion recovery images.According to statistical tests,the demographics(including gender,age),clinical data(including Fasting plasma glucose dyslipidemia)and imaging features were compared between the two groups.At last,logistic regression analysis were used to analyze the predictive factors for acute neurological deterioration after isolated pontine infarction.Results: 1.A total of 138 patients with isolated pontine infarction were enrolled.46 patients were diagnosed with END,and other 92 patients were among the non-END group.Univariate analysis showed that the Fasting plasma glucose of END group is higher than non-END group(8.33±2.93mmol/L vs.7.19±2.87mmol/L,t=-2.178,P=0.031).The admission NIHSS scores in END group is higher than non-END group(3.65±2.77 vs.2.37±2.06,t=-2.783,P=0.007).the scores of modified Rankin Scale(mRS)in END group is higher than non-END group(3.15±0.94 vs.0.99±1.02,t=-12.050,P=0.000).The proportion of patients with mRS>3 in END group was significantly higher in non-END group [35(76.1%)对 9(9.8%),X2=62.077,P=0.000]。Of the 138 patients,the stroke subtypes were classified as follow:43patients(31%)Large artery occlusive desease,55 patients(40%)Basilar artery branch disease,40 patients(29%)Small-artery disease.2.The comparison of image information between END group and non-END group:Univariate analysis showed that the ratio of lower potine infarction in END group was significantly higher than non-END group([18(39.1%)vs.16(17.4%),X2=7.805,P=0.005].The biggest diameter of infarction in END group is higher than non-END group(14.00±5.03 mm vs.10.21±4.52 mm,t=-4.472,P=0.000).The proportion of patients with the biggest diameter of infarction>15 in END group is higher than non-END group[(15/46(32.6%)vs.15/92(16.3%)X2=4.792,P=0.029].The proportion of patients with the pontine ventral surface infarction in END group is higher than non-END group [41(89.1%)vs.48(52.2%),X2=18.29,P=0.000];basilar artery stenosis or occlusionin in END group were significantly higher than non-END group[22/46(52.2%)vs.22/92(23.9%),X2=11.022,P=0.001].severe periventricular white matter hyperintensity in END group were significantly higher than non-END group[30(65.2%)vs.32(34.8%),X2=11.480,P=0.001];subcortical white matter hyperintensity in END group were significantly higher than non-END group [35(76.1%)vs.40(43.5%),X2=13.143,P=0.000].3.Logistic regression analysis identified that lower pontine infarction [OR=3.686,95% confidence interval 1.310~10.372,P=0.013].the pontine ventral surface infarction[OR=6.695,95%CI 1.996~22.450,P=0.002]、severe periventricular white matter hyperintensity[OR=2.540,95%CI 1.035~6.236,P=0.042] and subcortical whitematter hyperintensity [OR=2.624,95%CI 1.037~6.644,P=0.042] were the independent risk factor of END in pontine infarction.Conclusion:1.Lower pontine infarction,the pontine ventral surface infarction,severe periventricular white matter hyperintensity and subcorical white matter hyperintensity is one of the predictors of END in pontine infarction2.BABD is the main causes of pontine infarction.