Lesion volume increase is related to neurologic progression in patients with subcortical infarction

Abstract

It remains unknown whether subacute lesion volume increase is related to neurologic progression (NP) and clinical outcome (CO) in patients with single subcortical infarct (SSI) in the middle cerebral artery (MCA) territory. We studied 77 patients who underwent diffusion-weighted MRI (DWI) within 48 h after stroke onset, which revealed unilateral SSI in the MCA territory, and follow-up DWI and MR angiography within 7 days of onset. Neurologic progression was defined as the increase of the National Institutes of Health Stroke Scale (NIHSS) score by ≥2 during the first week. Clinical outcome was dichotomized as good (≤2) and poor (≥3) according to the modified Rankin Scale at 1 month after the onset. Lesion volume increase was defined when the infarct volume in the follow-up MRI exceeds the initial one by either ≥30% or 50%. Fourteen patients (18.2%) had NP, and 17 (22.1%) had poor CO. Increase in lesion volume, found in 42 patients (54.5%) when defined by 50% increase and in 51 (66.2%) by 30%, was significantly associated with NP (50%, p=0.010; 30%, p=0.027) and poor CO (50%, p=0.040; 30%, 0.111). Multivariate logistic analyses revealed that lesion volume increase was independently related to NP (odd ratio, 8.48; 95% CI, 1.55–46.46) and that NP was the important predictor for poor CO (odd ratio, 39.69; 95% CI, 3.44–458.68). We conclude that subacute lesion volume growth is closely related to the NP and that the NP predicts subsequent poor CO.