Predictors for Early Neurological Deterioration in Lacunar Infarction

Song, Young Mok

Abstract

BACKGROUND
Patients with lacunar infarction often show neurological deterioration during the acute period of stroke. The aim of this study was to identify the predictors for early neurological deterioration (END) in patients with lacunar infarction using clinical variables and the findings of diffusion-weighted imaging (DWI).
METHODS
This study involved 104 consecutive patients with acute lacunar infarction in the lenticulostriate artery territory who were admitted within 24 hours after onset between January 2010 and October 2014. END was defined as a decrease of > or =1 point in the National Institutes of Health Stroke Scale (NIHSS) motor score or > or =2 points in the total NIHSS score during the first 7 days after stroke onset. Clinical characteristics including initial NIHSS score, vascular risk factors, laboratory parameters, and DWI findings including the size, location, and shape of the lacunar infarction were evaluated to identify predictors for END.
RESULTS
END occurred in 25 (24%) patients with lacunar infarction. The initial NIHSS score (odds ratio, 1.47; p=0.01), number of infarct slices (odds ratio, 1.95; p<0.01), and infarction with an irregular shape (odds ratio, 2.87; p=0.048) were independently associated with END in multivariable logistic regression analysis. In receiver operating characteristic curve analysis, the best threshold for predicting END was an NIHSS score of 4 points (sensitivity, 72%; specificity, 68%) and an infarct slice number of 3 (sensitivity, 84%; specificity, 62%).
CONCLUSIONS
This study suggests that the initial NIHSS score, number of infarct slices, and an irregular lesion shape are independent predictors for END.