The Relationship Between Cerebral Small Vessel Disease And Early Neurological Deterioration In Patients With Acute Ischemic Strok

Objective:To explore the relationship between the different types of cerebrovascular diseases and the early deterioration of neurological function in patients with acute ischemic stroke.Methods:From September 2017 to February 2018,patients with acute ischemic stroke who were hospitalized in neurology department of the First Affiliated Hospital of China Medical University were collected prospectively(onset time<7 days).All patients were required to examine MRI in our hospital to diagnose and evaluate the type and imaging characteristics of cerebrovascular disease.Early neurological deterioration was defined as the aggravation of neurological deficit symptoms in patients with acute ischemic stroke within 2 weeks after admission,with an increase of at least 2 points in the total NHISS score,or at least 1 point in the individual score of consciousness level or muscle strength,or a new manifestation of neurological injury.TIA was diagnosed if the symptoms of neurological deficit were relieved completely within 24 hours and no new ischemic focus was found on DWI.At the same time,we collected the clinical and laboratory data and the imaging data of leukoaraiosis,perivascular space and lacuna in different degrees,and compared the differences between the early neurologic deterioration group and the non early neurologic deterioration group.Single factor analysis was used to screen the risk factors related to early neurological deterioration,and then we used logistic regression analysis to elect independent risk factors related to early neurological deterioration.Results:1.A total of 414 patients with acute ischemic stroke were enrolled in this study.Of which,91 cases of them had early neurological deterioration,accounting for22.0%.2.Compared with the group without early neurological deterioration,univariate analysis showed there were significant differences between the two groups in blood uric acid,homocysteine,NHISS score,stroke history,smoking,drinking,focus location,BG PVS,leukoaraiosis,and intracranial artery stenosis(P<0.05).In the two groups,no significant difference was found in hemoglobin,LDL,fasting blood glucose,gender,age,hypertension,diabetes,atrial fibrillation,coronary heart disease,dyslipidemia,antiplatelet drugs,statins,thrombolysis,CS PVS and lacuna(P>0.05).3.With the increase of BG PVS level,the incidence of early neurological deterioration increased(?~2=9.976,P=0.002<0.05).With the increase of leukoaraiosis from no weight,the incidence of early neurological deterioration increased(?~2=13.276,P<0.001).4.Using logistic regression analysis to study the influence of multiple factors on the early deterioration of neurological function.Stroke history,BG PVS,leukoaraiosis and intracranial vascular stenosis are independent risk factors of early neurological deterioration.5.In different CISS types,Kruskal Wallis H test was used to study the relationship between the severity of leukoaraiosis and the deterioration.There was a significant difference in the degree of leukoaraiosis between the early neurologic deterioration group and the non early neurologic deterioration group in the large artery group(?~2=16.795,P<0.001).There was no significant difference in the degree of leukoaraiosis in other groups.Conclusion:1.In patients with acute ischemic stroke,leukoaraiosis and enlarged perivascular space in basal ganglia are associated with early deterioration of neurological function.2.In patients with acute ischemic stroke,the risk of early neurological deterioration increases with the increase of leukoaraiosis.With the aggravation of the enlarged perivascular space in the basal ganglia,the risk of early neurologic deterioration increases.3.In patients with acute ischemic stroke,stroke history,BG PVS,leukoaraiosis and intracranial vascular stenosis are independent risk factors of early neurological deterioration.4.For different CISS types,the severity of leukoaraiosis is related to early neurological deterioration in patients with large atherosclerotic cerebral infarction,while in other types,the severity of leukoaraiosis is not related to early neurological deterioration.