Journal
STROKE
Volume 44, Issue 9, Pages 2462-2467Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/STROKEAHA.113.001467
Keywords
cerebral infarction; high-resolution MRI; plaque; atherosclerotic
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Funding
- Brain Research Center of the 21st Century Frontier Research Program
- Ministry of Science and Technology of Korea [M103KV010010 06K2201 01010]
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Background and Purpose Single subcortical infarction (SSI) may be classified as proximal SSI (pSSI) or distal SSI (dSSI) according to its extension to the middle cerebral artery (MCA). We investigated the differences between pSSI and dSSI in terms of their clinical features, lesion size, and the frequency of MCA plaques detected by high-resolution MRI. Methods Thirty-nine patients with SSI (20 pSSI and 19 dSSI) were prospectively enrolled who did not show relevant MCA disease on MR angiography. Lesion size, neurological status (initial National Institutes of Health Stroke Scale score and modified Rankin Scale at 3 months), and the presence and location (superior versus inferior) of high-resolution MRI-identified plaques were evaluated. Results The frequencies of MCA plaques did not differ between patients with pSSI and those with dSSI (8 [40%] versus 12 [63.2%]; P=0.205); however, superiorly located plaques were significantly more common in patients with pSSI than in those with dSSI (6 [75%] versus 2 [16.7%]; P=0.019). Initial lesion volumes were larger (1.961.18 versus 1.11 +/- 1.11 mm(3); P=0.025), National Institutes of Health Stroke Scale scores were higher (5 [3-6.75] versus 3 [1-3] points; P=0.017), and microbleeds were fewer (1 [5%] versus 10 [52.6%]; P=0.001) in patients with pSSI than in those with dSSI. Three-month modified Rankin Scale scores were higher in patients with superior plaques than in those with inferior plaques. Conclusions Compared with dSSI, pSSI is closely associated with large lesions, severe clinical symptoms, and superiorly located MCA plaques, suggesting that the location, rather than simple presence of plaques, determines the SSI location.
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