Comparative Study On The Clinical Characteristics And Prognosis Of Mild Cerebral Infarction Patients With Anterior Circulation And Posterior Circulation

Aims:To compare the clinical characteristics and prognosis of mild cerebral infarction between anterior circulation and posterior circulation,and to determine whether different infarct sites(anterior circulation infarction and posterior circulation infarction)are independent influencing factors of poor prognosis.So as to provide reference for early individualized treatment and long-term secondary prevention.Methods:This was a retrospective study of 402 patients of mild cerebral infarction with NIHSS(National Institute of Health stroke scale)score ≤ 5 who were admitted to the department of neurology of the second affiliated Hospital of Dalian Medical University from September 2017 to August 2018.(1)According to the infarct position displayed on magnetic resonance imaging-diffusion weighted imaging(MRI-DWI),the patients were divided into two groups: anterior circulation infarction(ACI)group and posterior circulation infarction(PCI)group.General data of patients were recorded,including baseline data(age,sex,history of smoking,history of alcohol consumption,history of stroke,hypertension,diabetes,coronary heart disease,atrial fibrillation),clinical data(etiological classification of TOAST [Trial of Org 10 172 in acute stroke treatment],NIHSS score at admission,time of visit,intravenous thrombolysis therapy and dual antiplatelet therapy),imaging data(infarct volume calculated from MRI results,intracranial or extracranial macrovascular stenosis,number of macroangiopathy),laboratory indicators for the first time since the onset of the disease(including fasting blood glucose,glycosylated hemoglobin,fibrinogen,total cholesterol,triglyceride,high density lipoprotein cholesterol,low-density lipoprotein cholesterol,apolipoprotein A1,apolipoprotein B)and main clinical symptoms and signs(limb weakness,central facial palsy,dysarthria,hemisensory deficits,cognitive impairment,visual impairment,nystagmus,vertigo,nausea and vomiting,bucking and dysphagia,ataxia).Univariate analysis was used to compare the differences between the ACI group and the PCI group.(2)The prognosis was evaluated by modified Rankin score(mRS).The patients with mild cerebral infarction were further divided into good prognosis group(mRS score ≤ 2)and poor prognosis group(mRS score > 2)according to the prognosis of 3 months after the onset of mild cerebral infarction.Univariate analysis and multivariate Logistic regression analysis were used to find out the independent risk factors for poor prognosis and to determine whether the infarct location(PCI and ACI)was the independent risk factor for poor prognosis 3 months after onset.Results: 1.402 patients with mild cerebral infarction were included in this study,including 249 patients(61.94%)in ACI group,with an average age of 65.32 ± 10.84 years,male 151 cases(60.64%);There were 153 cases(38.06%)in PCI group,with an average age of 63.69 ± 9.76 years old,and 101 cases(66.01%)in male group.The results of follow-up showed that 63 cases(15.67%)had poor prognosis,32 cases(12.85%)in ACI group had poor prognosis and 31 cases(20.26%)had poor prognosis in PCI group.2.Comparison of mild cerebral infarction between anterior circulation and posterior circulation: There were significant differences between the mild ACI group and the PCI group in the following aspects: hypertension,diabetes,fasting blood glucose,glycosylated hemoglobin,etiological classification of TOAST,NIHSS score at admission,infarct volume,and some clinical symptoms and signs(limb weakness,central facial palsy,hemisensory deficits,cognitive impairment,visual impairment,nystagmus,vertigo,nausea and vomiting,bucking and dysphagia,ataxia)(P<0.05).3.Comparison between good prognosis group and poor prognosis group: There were significant differences between the good prognosis group and the poor prognosis group in the following aspects: the infarct site(ACI and PCI),age,sex,diabetes mellitus,coronary heart disease,etiological classification of TOAST,NIHSS score at admission,dual antiplatelet therapy,infarct volume,intracranial or extracranial macrovascular stenosis,number of macroangiopathy,fasting blood glucose and fibrinogen(P<0.05).In addition,PCI,admission NIHSS score and number of macroangiopathy are independent risk factors for poor prognosis of mild cerebral infarction(P<0.05).Conclusion: 1.In patients with mild cerebral infarction,ACI had higher NIHSS score at admission and larger infarct volume than those with PCI,and the proportion of major atherosclerosis type,cardiogenic embolism type and other cause type in TOAST was higher than that in PCI patients,while PCI had more hypertension,diabetes and higher fasting blood glucose and glycosylated hemoglobin levels than those with ACI,The percentage of occlusive type of small vessel disease in TOAST was higher than that in ACI.2.Compared with mild ACI patients,vertigo,hemisensory deficits,ataxia,nausea and vomiting,nystagmus,visual impairment,bucking and dysphagia were more common in mild PCI patients,but limb weakness,central facial palsy and cognitive impairment were more common in mild ACI patients.3.In patients with mild cerebral infarction,PCI patients had a higher risk of poor prognosis at 3 months compared with patients with ACI.