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Clinical features and imaging markers of small vessel disease in symptomatic acute subcortical cerebral microinfarcts

BACKGROUND: As currently defined, recent small subcortical infarcts (RSSI) do not have a lower size boundary, and the smallest diffusion-weighted imaging (DWI) infarcts, which we term acute subcortical cerebral microinfarcts (As-CMI) with lesion diameter less than 5 mm, might have clinical implicati...

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Autores principales: Tao, Wendan, Cheng, Yajun, Guo, Wen, Kwapong, William Robert, Ye, Chen, Wu, Bo, Zhang, Shuting, Liu, Ming
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9396904/
https://www.ncbi.nlm.nih.gov/pubmed/35999494
http://dx.doi.org/10.1186/s12883-022-02824-w
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author Tao, Wendan
Cheng, Yajun
Guo, Wen
Kwapong, William Robert
Ye, Chen
Wu, Bo
Zhang, Shuting
Liu, Ming
author_facet Tao, Wendan
Cheng, Yajun
Guo, Wen
Kwapong, William Robert
Ye, Chen
Wu, Bo
Zhang, Shuting
Liu, Ming
author_sort Tao, Wendan
collection PubMed
description BACKGROUND: As currently defined, recent small subcortical infarcts (RSSI) do not have a lower size boundary, and the smallest diffusion-weighted imaging (DWI) infarcts, which we term acute subcortical cerebral microinfarcts (As-CMI) with lesion diameter less than 5 mm, might have clinical implications distinct from RSSI. We aimed to investigate the distinct characteristics of As-CMI as compared to the larger size of RSSI regarding vascular risk factors, clinical manifestation, radiological markers of SVD distribution, and outcomes. METHODS: In a consecutive cohort, patients were selected with a magnetic resonance DWI-confirmed RSSI between January 2010 and November 2020. We measured axial infarct diameter and classified patients into two groups: The As-CMI group (diameter < 5 mm) versus the Larger RSSI group (diameter 5-20 mm). Clinical variables, including vascular risk factors, clinical symptoms/signs, lesion locations, and radiological markers of cerebral small vessel disease (SVD) on MRI were analyzed between the two groups. Patients were followed up for 12 months and functional outcomes were measured by the modified ranking scale (mRS). RESULTS: In a total of 584 patients with RSSI, 23 (3.9%) were defined as As-CMI. The most common neurological deficits with As-CMI were hemiparalysis (n = 20), followed by central facial/lingual palsy (n = 10) and hemidysesthesia (n = 10). Most As-CMIs were located in the basal ganglia (n = 11), followed by the thalamus (n = 5) and centrum semiovale (n = 4). No different regional distributions and symptoms/signs frequencies were found between the two groups except for a lower percentage of dysarthria in the As-CMI group (p = 0.008). In a multivariate analysis, patients with As-CMI were independently associated with the presence of lacunes (adjusted odds ratio [aOR] 2.88; 95% confidence interval [CI] 1.21–6.84), multiple lacunes (aOR 3.5, CI 1.29–9.48) and higher total SVD burden (aOR 1.68, CI 1.11–2.53). Patients with As-CMI did not show a better functional outcome after 12 months of follow-up. CONCLUSIONS: Patients with As-CMI had a non-specific clinical profile but a higher burden of SVD, indicating As-CMI might be s sign of more severe small vascular injury. Whether its vascular features are associated with worse cognitive outcomes requires further investigation.
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spelling pubmed-93969042022-08-24 Clinical features and imaging markers of small vessel disease in symptomatic acute subcortical cerebral microinfarcts Tao, Wendan Cheng, Yajun Guo, Wen Kwapong, William Robert Ye, Chen Wu, Bo Zhang, Shuting Liu, Ming BMC Neurol Research BACKGROUND: As currently defined, recent small subcortical infarcts (RSSI) do not have a lower size boundary, and the smallest diffusion-weighted imaging (DWI) infarcts, which we term acute subcortical cerebral microinfarcts (As-CMI) with lesion diameter less than 5 mm, might have clinical implications distinct from RSSI. We aimed to investigate the distinct characteristics of As-CMI as compared to the larger size of RSSI regarding vascular risk factors, clinical manifestation, radiological markers of SVD distribution, and outcomes. METHODS: In a consecutive cohort, patients were selected with a magnetic resonance DWI-confirmed RSSI between January 2010 and November 2020. We measured axial infarct diameter and classified patients into two groups: The As-CMI group (diameter < 5 mm) versus the Larger RSSI group (diameter 5-20 mm). Clinical variables, including vascular risk factors, clinical symptoms/signs, lesion locations, and radiological markers of cerebral small vessel disease (SVD) on MRI were analyzed between the two groups. Patients were followed up for 12 months and functional outcomes were measured by the modified ranking scale (mRS). RESULTS: In a total of 584 patients with RSSI, 23 (3.9%) were defined as As-CMI. The most common neurological deficits with As-CMI were hemiparalysis (n = 20), followed by central facial/lingual palsy (n = 10) and hemidysesthesia (n = 10). Most As-CMIs were located in the basal ganglia (n = 11), followed by the thalamus (n = 5) and centrum semiovale (n = 4). No different regional distributions and symptoms/signs frequencies were found between the two groups except for a lower percentage of dysarthria in the As-CMI group (p = 0.008). In a multivariate analysis, patients with As-CMI were independently associated with the presence of lacunes (adjusted odds ratio [aOR] 2.88; 95% confidence interval [CI] 1.21–6.84), multiple lacunes (aOR 3.5, CI 1.29–9.48) and higher total SVD burden (aOR 1.68, CI 1.11–2.53). Patients with As-CMI did not show a better functional outcome after 12 months of follow-up. CONCLUSIONS: Patients with As-CMI had a non-specific clinical profile but a higher burden of SVD, indicating As-CMI might be s sign of more severe small vascular injury. Whether its vascular features are associated with worse cognitive outcomes requires further investigation. BioMed Central 2022-08-23 /pmc/articles/PMC9396904/ /pubmed/35999494 http://dx.doi.org/10.1186/s12883-022-02824-w Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Tao, Wendan
Cheng, Yajun
Guo, Wen
Kwapong, William Robert
Ye, Chen
Wu, Bo
Zhang, Shuting
Liu, Ming
Clinical features and imaging markers of small vessel disease in symptomatic acute subcortical cerebral microinfarcts
title Clinical features and imaging markers of small vessel disease in symptomatic acute subcortical cerebral microinfarcts
title_full Clinical features and imaging markers of small vessel disease in symptomatic acute subcortical cerebral microinfarcts
title_fullStr Clinical features and imaging markers of small vessel disease in symptomatic acute subcortical cerebral microinfarcts
title_full_unstemmed Clinical features and imaging markers of small vessel disease in symptomatic acute subcortical cerebral microinfarcts
title_short Clinical features and imaging markers of small vessel disease in symptomatic acute subcortical cerebral microinfarcts
title_sort clinical features and imaging markers of small vessel disease in symptomatic acute subcortical cerebral microinfarcts
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9396904/
https://www.ncbi.nlm.nih.gov/pubmed/35999494
http://dx.doi.org/10.1186/s12883-022-02824-w
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