Hemodynamic factors may play a critical role in neurological deterioration occurring within 72 hrs after lacunar stroke

Yen Chu Huang; Yuan Hsiung Tsai; Jiann Der Lee; Hsu Huei Weng; Leng Chieh Lin; Ya Hui Lin; Chih Ying Wu; Ying Chih Huang; Huan Lin Hsu; Meng Lee; Hsin Ta Yang; Chia Yu Hsu; Yi Ting Pan; Jen Tsung Yang

doi:10.1371/journal.pone.0108395

Hemodynamic factors may play a critical role in neurological deterioration occurring within 72 hrs after lacunar stroke

Yen Chu Huang^*, Yuan Hsiung Tsai, Jiann Der Lee, Hsu Huei Weng, Leng Chieh Lin, Ya Hui Lin, Chih Ying Wu, Ying Chih Huang, Huan Lin Hsu, Meng Lee, Hsin Ta Yang, Chia Yu Hsu, Yi Ting Pan, Jen Tsung Yang

^*Corresponding author for this work

Chang Gung University

Research output: Contribution to journal › Journal Article › peer-review

24 Scopus citations

Abstract

Results: Ten out of the 43 patients had END. Patients having END was significantly associated with lower chances of favorable and good outcomes at 3 months (p = 0.01 and p = 0.002, respectively). END was predicted when the non-core hypoperfused area overlapped on the corticospinal tract, which is defined as the expected END profile. Cohen's Kappa coefficient between the 2 image readers to define images of expected END profiles was 0.74. In 15 patients with expected END profile, 9 had END clinically, whereas 28 patients had no expected END profile, and only 1 patient had END (p<0.0001). After adjusting for sex, the expected END profile was still associated with END (odds ratio, 42.2; p = 0.002).

Conclusion: Our study demonstrated that the END in acute lacunar stroke is likely related to the transformation of non-core hypoperfused area into infarction in the anatomy of corticospinal tracts.

Background: Whether a perfusion defect exists in lacunar infarct and whether it is related to early neurological deterioration (END) is still under debate. The aim of this study was to evaluate whether END in lacunar infarct is related to a perfusion defect using diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI) and perfusion MR imaging.

Methods: One hundred and forty-one consecutive patients had an MRI scan within 30 hours after onset of symptoms and 43 patients with acute lacunar infarct and classic lacunar syndrome were recruited. The MRI sequences included DWI, DTI and cerebral blood flow (CBF) maps to respectively represent the topographic locations of acute infarcts, the corticospinal tract and perfusion defects. The END was defined in reference to the National Institute of Health Stroke Scale (NIHSS) as an increase ≥2 within 72 hours. Cohen's Kappa coefficient was used to examine the reliability between the 2 image readers. A multivariate logistic regression model was constructed adjusting for baseline variables.

Original language	English
Article number	e108395
Journal	PLoS ONE
Volume	9
Issue number	10
DOIs	https://doi.org/10.1371/journal.pone.0108395
State	Published - 23 10 2014

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© 2014 Huang et al.

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Huang, Y. C., Tsai, Y. H., Lee, J. D., Weng, H. H., Lin, L. C., Lin, Y. H., Wu, C. Y., Huang, Y. C., Hsu, H. L., Lee, M., Yang, H. T., Hsu, C. Y., Pan, Y. T., & Yang, J. T. (2014). Hemodynamic factors may play a critical role in neurological deterioration occurring within 72 hrs after lacunar stroke. PLoS ONE, 9(10), Article e108395. https://doi.org/10.1371/journal.pone.0108395

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title = "Hemodynamic factors may play a critical role in neurological deterioration occurring within 72 hrs after lacunar stroke",

abstract = "Results: Ten out of the 43 patients had END. Patients having END was significantly associated with lower chances of favorable and good outcomes at 3 months (p = 0.01 and p = 0.002, respectively). END was predicted when the non-core hypoperfused area overlapped on the corticospinal tract, which is defined as the expected END profile. Cohen's Kappa coefficient between the 2 image readers to define images of expected END profiles was 0.74. In 15 patients with expected END profile, 9 had END clinically, whereas 28 patients had no expected END profile, and only 1 patient had END (p<0.0001). After adjusting for sex, the expected END profile was still associated with END (odds ratio, 42.2; p = 0.002).Conclusion: Our study demonstrated that the END in acute lacunar stroke is likely related to the transformation of non-core hypoperfused area into infarction in the anatomy of corticospinal tracts.Background: Whether a perfusion defect exists in lacunar infarct and whether it is related to early neurological deterioration (END) is still under debate. The aim of this study was to evaluate whether END in lacunar infarct is related to a perfusion defect using diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI) and perfusion MR imaging.Methods: One hundred and forty-one consecutive patients had an MRI scan within 30 hours after onset of symptoms and 43 patients with acute lacunar infarct and classic lacunar syndrome were recruited. The MRI sequences included DWI, DTI and cerebral blood flow (CBF) maps to respectively represent the topographic locations of acute infarcts, the corticospinal tract and perfusion defects. The END was defined in reference to the National Institute of Health Stroke Scale (NIHSS) as an increase ≥2 within 72 hours. Cohen's Kappa coefficient was used to examine the reliability between the 2 image readers. A multivariate logistic regression model was constructed adjusting for baseline variables.",

author = "Huang, {Yen Chu} and Tsai, {Yuan Hsiung} and Lee, {Jiann Der} and Weng, {Hsu Huei} and Lin, {Leng Chieh} and Lin, {Ya Hui} and Wu, {Chih Ying} and Huang, {Ying Chih} and Hsu, {Huan Lin} and Meng Lee and Yang, {Hsin Ta} and Hsu, {Chia Yu} and Pan, {Yi Ting} and Yang, {Jen Tsung}",

note = "Publisher Copyright: {\textcopyright} 2014 Huang et al.",

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doi = "10.1371/journal.pone.0108395",

language = "英语",

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T1 - Hemodynamic factors may play a critical role in neurological deterioration occurring within 72 hrs after lacunar stroke

AU - Huang, Yen Chu

AU - Tsai, Yuan Hsiung

AU - Lee, Jiann Der

AU - Weng, Hsu Huei

AU - Lin, Leng Chieh

AU - Lin, Ya Hui

AU - Wu, Chih Ying

AU - Huang, Ying Chih

AU - Hsu, Huan Lin

AU - Lee, Meng

AU - Yang, Hsin Ta

AU - Hsu, Chia Yu

AU - Pan, Yi Ting

AU - Yang, Jen Tsung

PY - 2014/10/23

Y1 - 2014/10/23

N2 - Results: Ten out of the 43 patients had END. Patients having END was significantly associated with lower chances of favorable and good outcomes at 3 months (p = 0.01 and p = 0.002, respectively). END was predicted when the non-core hypoperfused area overlapped on the corticospinal tract, which is defined as the expected END profile. Cohen's Kappa coefficient between the 2 image readers to define images of expected END profiles was 0.74. In 15 patients with expected END profile, 9 had END clinically, whereas 28 patients had no expected END profile, and only 1 patient had END (p<0.0001). After adjusting for sex, the expected END profile was still associated with END (odds ratio, 42.2; p = 0.002).Conclusion: Our study demonstrated that the END in acute lacunar stroke is likely related to the transformation of non-core hypoperfused area into infarction in the anatomy of corticospinal tracts.Background: Whether a perfusion defect exists in lacunar infarct and whether it is related to early neurological deterioration (END) is still under debate. The aim of this study was to evaluate whether END in lacunar infarct is related to a perfusion defect using diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI) and perfusion MR imaging.Methods: One hundred and forty-one consecutive patients had an MRI scan within 30 hours after onset of symptoms and 43 patients with acute lacunar infarct and classic lacunar syndrome were recruited. The MRI sequences included DWI, DTI and cerebral blood flow (CBF) maps to respectively represent the topographic locations of acute infarcts, the corticospinal tract and perfusion defects. The END was defined in reference to the National Institute of Health Stroke Scale (NIHSS) as an increase ≥2 within 72 hours. Cohen's Kappa coefficient was used to examine the reliability between the 2 image readers. A multivariate logistic regression model was constructed adjusting for baseline variables.

AB - Results: Ten out of the 43 patients had END. Patients having END was significantly associated with lower chances of favorable and good outcomes at 3 months (p = 0.01 and p = 0.002, respectively). END was predicted when the non-core hypoperfused area overlapped on the corticospinal tract, which is defined as the expected END profile. Cohen's Kappa coefficient between the 2 image readers to define images of expected END profiles was 0.74. In 15 patients with expected END profile, 9 had END clinically, whereas 28 patients had no expected END profile, and only 1 patient had END (p<0.0001). After adjusting for sex, the expected END profile was still associated with END (odds ratio, 42.2; p = 0.002).Conclusion: Our study demonstrated that the END in acute lacunar stroke is likely related to the transformation of non-core hypoperfused area into infarction in the anatomy of corticospinal tracts.Background: Whether a perfusion defect exists in lacunar infarct and whether it is related to early neurological deterioration (END) is still under debate. The aim of this study was to evaluate whether END in lacunar infarct is related to a perfusion defect using diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI) and perfusion MR imaging.Methods: One hundred and forty-one consecutive patients had an MRI scan within 30 hours after onset of symptoms and 43 patients with acute lacunar infarct and classic lacunar syndrome were recruited. The MRI sequences included DWI, DTI and cerebral blood flow (CBF) maps to respectively represent the topographic locations of acute infarcts, the corticospinal tract and perfusion defects. The END was defined in reference to the National Institute of Health Stroke Scale (NIHSS) as an increase ≥2 within 72 hours. Cohen's Kappa coefficient was used to examine the reliability between the 2 image readers. A multivariate logistic regression model was constructed adjusting for baseline variables.

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Hemodynamic factors may play a critical role in neurological deterioration occurring within 72 hrs after lacunar stroke

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