The relationship between progressive motor deficits and lesion location in patients with single infarction in the lenticulostriate artery territory
The relationship between progressive motor deficits and lesion location in patients with single infarction in the lenticulostriate artery territory
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DOI：
10.1007/s00415-017-8533-9
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发表时间：
2017-07-01
影响因子：
6
通讯作者：
Akiguchi, Ichiro
中科院分区：
文献类型：
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作者：
Yamamoto, Yasumasa;Nagakane, Yoshinari;Akiguchi, Ichiro
由于皮质脊髓束在后段穿过脑纹动脉（LSA）区域，我们假设LSA的后部梗死可能与进行性运动障碍有关。我们前瞻性研究了519例连续的LSA梗死患者，他们在发病后24小时内进入我们的医院。我们根据进展将患者分为两组：无进展和进展。进展定义为美国国立卫生研究院卒中量表（NIHSS）恶化1分或以上，其中一些随后恢复或彻底进展。第一次DWI上的LSA梗死分为近端型和远端型（第1组）。根据侧脑室前后径的中点，近端型又分为前型（第2组）、中型（第3组）和后型（第4组）。有109例患者出现进展，占所有患者的21.0%。进展的患者数量如下：远端型65例（23.8%）、前部型31例（36.0%）、中间型26例（56.5%）和后部型97例（85.0%）。Cochran-Armitage检验显示从第1组到第4组显著增加（p < 0.0001）。进展的独立预测因素为男性（OR 0.57，p = 0.0107）、入院时较高的NIHSS（ae 4）（OR 3.02，p < 0.0001）、中间近端型（OR 3.3，p = 0.0007）和后近端型（OR 16.4，p < 0.0001）。梗死位置越靠后，进展越频繁，可能是由于皮质脊髓束在后上象限穿过LSA区域的解剖事实。
As the corticospinal tracts cross the lenticulostriate artery (LSA) territory at the posterior segment, we hypothesized that posteriorly located infarctions of the LSA may be associated with progressive motor deficits. We prospectively studied 519 consecutive patients with LSA infarctions who entered our hospital within 24 h after onset. We categorized patients into two groups in terms of progress: no progress and progress. Progress was defined as worsening by 1 point or more in the National Institutes of Health Stroke Scale (NIHSS), some of which recovered afterward or thoroughly progressed. LSA infarctions on the first DWI were divided into proximal type and distal (group 1) type. The proximal type was further divided into anterior (group 2), intermediate (group 3) and posterior (group 4) type according to the middle point of antero-posterior diameter of the lateral ventricle. There were 109 patients who showed progress that accounted for 21.0% of all patients. The number of patients who progressed is as follows: distal type 65 (23.8%), anterior type 31 (36.0%), intermediate type 26 (56.5%) and posterior type 97 (85.0%). The Cochran-Armitage test showed a significant increase through group 1 to group 4 (p < 0.0001). Independent predictive factors for progress were male (OR 0.57, p = 0.0107), higher NIHSS on admission (ae4) (OR 3.02, p < 0.0001), intermediate proximal type (OR 3.3, p = 0.0007) and posterior proximal type (OR 16.4, p < 0.0001). The more posterior the infarct location, the more frequent was the progress that occurred, probably due to the anatomical fact that corticospinal tracts crossed the LSA territory at the posterosuperior quadrant.