Editors' Note: Early Neurologic Deterioration in Lacunar Stroke: Clinical and Imaging Predictors and Association With Long-term Outcome

Abstract

Early neurologic deterioration (END) is a frequent complication of acute ischemic stroke and is often due to progressive tissue infarction. In their single-center analysis of acute lacunar stroke identified on magnetic resonance imaging (n = 365), Dr. Vynckier and colleagues report 16.7% of patients experienced a worsening of 2 or more points in the NIH Stroke Scale within 24 hours of arrival and were classified as having END. It is important that milder stroke severity, ventral pontine injury, capsular warning syndrome, and hypoperfusion on baseline imaging were predictive of END. Dr. Alpert comments that early mobilization—while important for expediting rehabilitation and discharge—may increase the risk of END. Dr. Zini and colleagues also highlight the putative relationship between END and branch atheromatous disease, which may be targeted with combination antiplatelet therapy. Indeed, the study by Vynckier et al. found that acute dual antiplatelet therapy was associated with a 90% lower chance of END (adjusted odds ratio 0.10, 95% CI 0.01–0.89). Dual antiplatelet therapy may be useful for preventing progressive tissue infarction in lacunar disease; however, this can only be confirmed in a randomized clinical trial. Early neurologic deterioration (END) is a frequent complication of acute ischemic stroke and is often due to progressive tissue infarction. In their single-center analysis of acute lacunar stroke identified on magnetic resonance imaging (n = 365), Dr. Vynckier and colleagues report 16.7% of patients experienced a worsening of 2 or more points in the NIH Stroke Scale within 24 hours of arrival and were classified as having END. It is important that milder stroke severity, ventral pontine injury, capsular warning syndrome, and hypoperfusion on baseline imaging were predictive of END. Dr. Alpert comments that early mobilization—while important for expediting rehabilitation and discharge—may increase the risk of END. Dr. Zini and colleagues also highlight the putative relationship between END and branch atheromatous disease, which may be targeted with combination antiplatelet therapy. Indeed, the study by Vynckier et al. found that acute dual antiplatelet therapy was associated with a 90% lower chance of END (adjusted odds ratio 0.10, 95% CI 0.01–0.89). Dual antiplatelet therapy may be useful for preventing progressive tissue infarction in lacunar disease; however, this can only be confirmed in a randomized clinical trial.