Prediction of progressive motor deficits in patients with deep subcortical infarction.

Abstract

BACKGROUND AND PURPOSE: Early motor deterioration (EMD) in deep subcortical infarction is usually associated with long-term functional disability. In this study, we investigated the clinical characteristics, biochemical markers and MRI variables in patients with deep subcortical infarction to identify the predictors of progressive motor deficits.

METHODS: A total of 167 consecutive patients with deep subcortical infarction in the anterior circulation were included. All of the patients must have motor deficit as one of the presented symptoms. EMD was defined as a modified National Institutes of Health Stroke Scale (mNIHSS) motor score of >or=1 during the first week of symptom onset. The patients were assessed with clinical findings such as stroke risk factors, blood pressure on admission, laboratory variables and radiological findings; lesion characteristics on MRI, stenosis or occlusion in the relevant parental artery on MRA and diffusion/perfusion mismatch.

RESULTS: Twenty-three (13.8%) of the 167 patients revealed EMD. The independent factors related to the EMD in multiple regression analysis were initial high systolic blood pressure (OR = 1.035, 95% CI = 1.007-1.063; p = 0.013) and lesion involvement in the posterolateral striatum (OR = 15.98; 95% CI = 1.842-138.534; p = 0.012); however, the other clinical and radiological factors were not related.

CONCLUSIONS: The involvement of the posterolateral striatum appears to be an important predictor for EMD. It can be explained by (1) the lateral lenticulostriate artery (LSA), which supplies the posterolateral striatum vulnerable to ischemic damage due to the lack of collateral vessels, and (2) the posterolateral division of the striatum may be susceptible to progressive motor deficit because of anatomic proximity to the corticospinal tract in the same LSA territory. Further research should include precise anatomical and functional study to determine the relationship between the posterolateral striatum and corticospinal tract in predicting progressive motor deficit.