Correlation of early neurological deterioration and white matter hyperintensities in patients with acute lacunar infarction

Abstract

Objective To investigate the predictors of early neurological deterioration (END) as well as the correlation between white matter hyperintensities (WMH) and END in patients with acute ischemic stroke. Methods Consecutive patients diagnosed as acute lacunar infarction and admitted to Jinling Hospital between 4.5 and 24.0 hours after symptom onset were prospectively recruited in the study. END was defined as an increase of National Institutes of Health Stroke Scale (NIHSS) score ≥2 points in the first 72 hours after admission. Besides, all patients received magnetic resonance imaging within 24 hours after admission. The WMH were graded according to the Fazekas rating scale. Results A total of 223 patients were finally enrolled. Of them, 70（31.4%）patients suffered END in the initial 72 hours after admission. Multivariable analysis indicated that systolic blood pressure (OR=1.02, 95% CI 1.00—1.04，P=0.049), baseline NIHSS score (OR=1.32，95% CI 1.15—1.52，P<0.01) and fasting plasma glucose on admission (OR=1.14，95% CI 1.01—1.29，P=0.034）were independent predictors for END. However, for periventricular WMH, compared to Fazekas grade 0, no statistically significant correlation existed between END and WMH grade 1, grade 2 and grade 3. For WMH in centrum semiovale, similarly, END did not correlate with WMH grade 1, grade 2 and grade 3. Likewise, in the post-hoc subgroup analysis of patients with different age, sex and different territory, END did not significantly correlate with WMH neither in periventricular nor in centrum semiovale. Conclusions Systolic blood pressure, baseline NIHSS score and the fasting plasma glucose on admission were independent predictors for END in patients with acute lacunar infarction. However, WMH located neither in periventricular spaces nor in centrum semiovale was related to END. Key words: Brain infarction; Leukoencephalopathies; Severity of illness index; Risk factors