Correlation Between Imaging Markers Of Cerebral Small Vessel Disease And Early Neurological Deterioration In Patients With Acute Ischemic Stroke

Objective To investigate the incidence of early neurological deterioration in patients with acute ischemic stroke and the correlation between the imaging markers of cerebral small vessel disease,total cerebral small vessel disease burden and early neurological deterioration in patients with acute ischemic stroke.Methods A total of 202 patients with acute ischemic stroke(AIS)who were hospitalized in the Department of Neurology,People’s Hospital of Taizhou from September 2021 to June 2022 were enrolled in this study.All patients underwent cranial magnetic resonance imaging(MRI)in our hospital within 3 days after admission.The general data,laboratory data and imaging data of the patients were collected,and the imaging markers of cerebral small vessel disease(CSVD)were:lacunar,white matter hyperintensity(WMH),enlarged perivascular space(EPVS),cerebral microbleed(CMB)were diagnosed and evaluated,and the total CSVD burden was calculated.All patients were evaluated by the National institutes of health stroke scale(NIHSS)at admission,and they were re-evaluated twice within 24 hours,48 hours and 72 hours after admission.Early neurological deterioration(END)was defined as an increase of≥2points in the NIHSS score or an increase of≥1 point in the NIHSS 1a,1b,or 1c(level of consciousness)or an increase of≥1 point in NIHSS 5 and 6(exercise)at any time within72 hours after admission.The patients were divided into END group and non-END group according to the presence or absence of END.First,univariate analysis was performed to screen out the risk factors related to END,and then they were included in multivariate logistic regression analysis to determine the independent risk factors related to END.Results 1.A total of 202 patients were finally enrolled in this study,of whom 35(17.3%)had early neurological deterioration.2.Univariate analysis of general clinical data between END group and non-END group showed that:There were no significant differences in age,gender,height,weight,smoking history,drinking history,baseline diastolic blood pressure,past medical history,homocysteine,uric acid,fasting blood glucose,TC,TG,HDL-C,LDL-C,infarct location and treatment plan after admission between the two groups(P>0.05).There were significant differences in baseline systolic blood pressure,glycosylated hemoglobin,and admission NHISS score between the two groups(P<0.05).In imaging data,there was no significant difference in lacunar,CMB and total burden of CSVD between the groups(P>0.05).There were significant differences in moderate to severe EPVS(43.1%vs 62.9%,P=0.03),moderate to severe WMH(40.1%vs 74.3%,P<0.001),and total WMH volume between the two groups(P<0.05).3.Baseline systolic blood pressure,glycosylated hemoglobin,admission NIHSS score,moderate to severe WMH,total WMH volume and moderate to severe EPVS were used as independent variables,a multifactorial logistic regression analysis was performed and showed that moderate to severe WMH(OR=0.292,95%CI 0.119-0.715,P=0.004),admission NIHSS score(OR=1.263,95%CI 1.077-1.481,P=0.007),and total WMH volume(OR=1.025,95%CI 1.002-1.049,P=0.03)were independent risk factors for END.4.According to the results of the chi-square test for linear trend,with the aggravation of WMH,the incidence of END was higher.There was a linear correlation between the severity of WMH and the incidence of END(x~2=8.275,P=0.004).With the aggravation of EPVS,the incidence of END was higher.There was a linear relationship between the severity of EPVS and the incidence of END(x~2=7.277,P=0.007).5.The volumes of periventricular WMH in the END group and the non-END group were 6.53(4.47,11.84)mm~3 and 3.10(1.16,7.35)mm~3 and the difference between the two groups was statistically significant(P<0.001).Further Spearman correlation analysis showed that there was a significant correlation between periventricular WMH volume and END(R=0.28,P=0.001).Conclusion1.Among the CSVD imaging markers,moderate to severe EPVS,moderate to severe WMH and total volume of WMH are related to the occurrence of END,while lacunar,CMB and total CSVD burden are not related to the occurrence of END.2.Moderate to severe WMH,total WMH volume and admission NIHSS score were independent risk factors for END.3.With the aggravation of WMH,the incidence of END is higher.With the aggravation of EPVS,the incidence of END is higher.4.There is a significant correlation between the volume of periventricular WMH and the occurrence of END.