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Exploring the Relationship between Lesion Morphology and Pathogenesis in Acute Small Subcortical Infarction
Yen-Chu Huang1,2, Jiann-Der Lee1,2, Leng-Chieh Lin3
1Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan.
Cerebrovascular Diseases (Basel, Switzerland)
|December 21, 2023
Summary
Acute small subcortical infarctions (SSIs) size and morphology predict clinical outcomes and underlying causes. Larger or separated lesions are linked to worse results and specific pathologies, challenging current stroke criteria.
Area of Science:
- Neurology
- Radiology
- Cardiology
Background:
- Acute small subcortical infarctions (SSIs) arise from penetrating artery occlusions, with varied pathological drivers and clinical implications.
- Understanding these factors is crucial for accurate diagnosis and treatment.
Purpose of the Study:
- To evaluate the clinical relevance of acute SSIs by analyzing their sizes and morphologies.
- To identify associations between SSI characteristics and underlying pathologies or clinical outcomes.
Main Methods:
- Retrospective case-control study of 726 stroke patients with SSIs on MRI within 5 days of onset (2016-2020).
- Patients categorized by SSI size (<20 mm, ≥20 mm) and morphology (separated lesions).
- Clinical characteristics and outcomes were assessed.
Main Results:
- Patients with SSIs ≥20 mm diameter showed higher NIHSS scores, increased risk of early neurological deterioration (END), and poorer functional outcomes.
- Separated lesions were significantly associated with cardioembolic stroke and parent artery stenosis >50%.
- SSIs ≥20 mm were linked to a higher risk of END (aOR, 2.9; 95% CI, 1.7-5.2).
Conclusions:
- SSI size and morphology correlate with distinct underlying pathologies and clinical outcomes.
- Findings suggest current imaging criteria for embolic stroke of undetermined source may need revision, as large SSIs were not definitively linked to cardioembolism.
Keywords:
Cardioembolic strokeEarly neurological deteriorationMagnetic resonance imagingSmall subcortical infarctionSmall vessel diseaseMore Related Videos
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