Predictors and pathogenesis of progressive motor deficits after acute subcortical cerebral infarction： a retrospective case series study

Abstract

Objective To investigate the predictors and pathogenesis of progressive motor deficits （PMD） after acute subcortical cerebral infarction. Methods Consecutive patients with acute subcortical cerebral infarction admitted to hospital within 24 hours of after onset were enrolled. They were divided into either a PMD group （increase ≥ 2 points within 5 days） or a non-PMD group according to the changes of motor scores of the National Institutes of Heakh Stroke Scale. The differences of demographics, imaging data and related risk factors were compared between two groups in order to screen for the early predictors for PMD. The reexamination of diffusion-weighted imaging （DWI） was conducted for all patients in the PMD group and part of patients in the non-PMD group. The pathogenesis of PMD was analyzed from the radiological point of view. Results A total of 117 patients with acute subcortical cerebral infarction within 24 hours of after onset were enrolled, 26 of them were in the PMD group, and 91 were in the non-PMD group. Univariate analysis showed that the proportions of the histoi＇y of previous stroke or transient ischemic attack of the PMD group were significantly lower than those of the non-PMD group （11.5% vs. 31.9% ; X^2 = 4. 206, P = 0. 040）; glycated hemoglobin （6. 7 % ± 2. 0% vs. 5.9 % ± 1.7 % ; t = - 2. 206, P = 0. 029） and infarction levels （3.7± 1.4vs. 3.0± 1.6, t= -2.147, P= 0.034） of the PMD group were significantly higher than those of the non-PMD group; the proportions of corona radiata infarct （73.1% .vs. 25.3%;X^2= 20. 081, P 〈 0. 001） and middle cerebral artery （MCA） stenosis or occlusion （76. 9% vs. 51.6% ;X2 =5. 279, P =0. 022） of the PMD group were significantly higher than those of the non-PMD group. Multivariate logistic regression analysis showed that corona radiata infarct （odds ratio [ OR] 10. 459, 95% confidence interval [ CI] 3. 091 - 35. 396; P 〈 0. 001） and MCA stenosis or occlusion （OR 4. 036, 95% CI 1. 057- 15. 417; P= 0. 041） were the independent predictors for PMD after acute subcortical cerebral infarction. The proportions of infarct expansion （50. 0% vs. 6. 5% ;X2 = 13. 830, P 〈0. 001） and recurrent infarction （38.5% vs. 3.2%; X2 = 11. 273, P = 0. 001） of the PMD group were significantly higher than those of the non-PMD group. However, the proportion of patients without any change （23.1% vs. 90. 3%; X2 =26. 566, P〈0. 001） was significantly lower than that of the non-PMD group. Conclusions Corona radiata infarct and MCA stenosis or occlusion are the important and independent predictors for PMD after acute subcortical cerebral infarction. Infarct expansion and recurrent infarction may be the main mechanism of PMD. Key words: Brain Infarction; Disease Progression; Motor Activity; Magnetic Resonance Imaging; Risk Factors