The Study Of Early Neurological Deterioration In Acute Ischemic Strok

At present,the pathogenesis of early neurological deterioration(END)in acute ischemic stroke(AIS)has not been fully elucidated,and it is lack of early diagnosis and early treatment.Most of the END is defined as an increasing of NIHSS score ≥2 in the first 72 hours after admission in most of recent studies.Due to the complex factors related to END induced by AIS,this study focuses on two groups of patients with minor ischemic stoke and acute lacunar stoke.investigating the related factors and possible mechanism of END in the two groups respectively will be helpful to provide END and to further improve the prognosis and the quality of the AIS group.Part I :The relationship between cerebral atherosclerosis score and early neurological deterioration in patients with minor ischemic strokeObjective:To investigate the correlation between cerebral atherosclerosis score(CAS)and early neurological deterioration(END)in patients with minor ischemic stroke.Methods:Patients with minor ischemic stroke(NIHSS≤3)in Anhui Provincial Hospital affiliated to Anhui Medical University were consecutively and prospectively recruited from January 2013 to December 2015.END was defined as an increase of NIHSS score ≥2 in the first 72 hours after admission.All subjects underwent magnetic resonance image(MRI),magnetic resonance angiography(MRA)and computerized tomography angiography(CTA)within 24 h after admission.The stenosis artery ≥ 50% was 1 point,assessment artery including middle cerebral(M1,M2,M3),anterior cerebral(A1,A2),posterior cerebral(P1,P2),basilar,intracranial carotid,vertebral,common carotid,innominate and subclavian arteries(Before the beginning of the vertebral artery).CAS was defined as the sum of the score for above-mentioned each artery segment.Receiver operator characteristic curve and the area under the curve were used to evaluate CAS for the predictive capability of END.The sensitivity and specificity were calculated,respectively.Results:A total of 265 patients were registered.END occurred in 39 cases(14.7%).Logistic regression analysis indicated that baseline NIHSS(OR = 2.24,95% CI: 1.34-3.75,P = 0.002),CAS(OR = 1.53,95% CI: 1.16-2.01,P = 0.002)and symptomatic artery stenosis ≥ 70%(OR = 2.15,95% CI: 1.05-4.44,P = 0.039)were independent risk factors for END.CAS identifying the best cutoff value of all patients with END was 2,and the sensitivity and specificity were 64.1% and 68.1%,respectively.Conclusion: Baseline NIHSS,CAS and symptomatic artery stenosis≥70% were independent predictors for END in patients with Minor ischemic stroke.Special attention should be paid to patients with CAS≥2.Part II : Correlation study between cerebral microbleeds and early neurological deterioration in patients with first-onset acute lacunar strokeObjective: The predictive indexes which affect END of patients with acute lacunar stroke still remain unclear.The purpose of the article was to investigate the correlation between the location and numbers of cerebral microbleeds(CMBs)and END in patients with first-onset lacunar stroke.Methods: Patients with acute lacunar stroke in Anhui Provincial Hospital affiliated to Anhui Medical University and Fuyang Tumour Hospital within the time frame of 24 hours were prospectively enrolled from March 2013 and May 2015.END was defined as increment of NIHSS score at least 2 points in the first 72 hours after admission.All patients underwent susceptibility-weighted imaging after admission.Results: A total of 217 patients were prospectively enrolled with average age of 60.0 years old.Eighty-one patients were CMBs positive after the SWI examination.END occurred in 76 patients despite of standard treatment,accounting for 35.0%.Among these patients,CMBs positive ones were 33,accounting for 43.3%,without significant differences between with and without CMBs groups.In the comparison of numbers of CMBs foci,patients with more than 5 foci were more prone to END(P = 0.005 in single variable analysis and OR = 3.14,95%CI: 1.22~8.13,P = 0.018 in the multivariable analysis compared with CMBs negative patients).In the comparison of CMBs location,there is no significant relationship to END no matter deep CMBs(OR = 1.76,95% CI: 0.91~3.39,P = 0.093),or other regions(OR = 0.75,95% CI: 0.16-3.56,P = 0.75).Conclusion: The distribution of CMBs foci has nothing to do with early neurological fluctuation.However,more than 5 CMBs foci are independently related to END.