Abstract
Background and Purpose: The progression of neurological deficits in patients suffering from small deep infarcts (SDIs) of the brain is difficult to predict. Therefore, we classified these infarcts into two subtypes, branch atheromatous disease (BAD) and non-BAD, and investigated the clinical characteristics of the progression cases.
Methods: One hundred sixteen patients with acute SDI were classified into 60 BAD cases and 56 non-BAD cases. The cases were then divided into progress and non-progress groups, and the clinical characteristics were compared.
Result: Twenty-nine patients showed progression of symptoms, 22 in the BAD group and 7 in the non-BAD group. Significantly more progression cases were in the BAD group (p=0.003). Serial neuroimaging using MRI was obtained for 68 patients, and 41 of these had progressive symptoms. The rate of patients with enlarged lesions was 81.4% in the BAD group, 24.0% in the non-BAD group, 48.9% in the non-progress group, and 82.6% in the progress group. The lesion was enlarged significantly more often in the BAD group (p<0.001) and the progress group (p=0.006). A history of diabetes mellitus was associated with progressing stroke (p=0.024). In the BAD group, infarcts in the lateral lenticulostriate artery region were less progressive (p=0.029), whereas those in the paramedian pontine region were more progressive (p=0.043). None of patients with lesions in thalamoperforating arteries had neurological deterioration. The non-progress group (p<0.001) and non-BAD group (p=0.006) showed good outcomes.
Conclusion: The clinical characteristics, classification as BAD or non-BAD, and the serial neuroimaging of patients with SDI are useful as predictors of progressing stroke.
