Analysis Of Pathogenesis Among Patients With Different Types Of Paramedian Pontine Infarction In Magnetic Resonance Diffusion Weighted Imaging

Objective: In the past study,it is believed that paramedian pontine infarction(PPI),can be caused by the mechanism of atherosclerosis or the mechanism of small vascular lesions.But which type of PPI is caused by factors of atherosclerosis or small vascular lesions is still not very clear.The aim of this study was to discuss the difference of pathogenesis of different types of PPI.At the same time,we analysed the early disease progression situation caused by different PPI.Methods: We selected 150 patients with acute phase PPI diagnosed by magnetic resonance diffusion weighted imaging(DWI).Depending on the type of basal artery narrow and PPI the patients was divided into groups: PPI Without basilar artery stenosis(basilar artery stenosis,PPI-BAS)and PPI with basilar artery stenosis(PPI+ BAS group);Not involving the the ventral surface of pons which is the dorsal infarction group(d PPI)and PPI involving the ventral surface of pons(v PPI)group;v PPI without BAS(v PPI-BAS);d PPI without BAS(d PPI-BAS).The prevalence of coronary atherosclerotic heart disease,diabetes,atherosclerosis,intracranial Internal carotid artery system atherosclerosis(Internal carotid artery atherosclerosis,ICAS),Extracranial artery atherosclerosis(Extracranial arterial atherosclerosis,EAAS)was compared between groups.The prevalence of leukoaraiosis(LA)and lacunars cerebral infarction(LI)was compared between groups.The National Institute of Health stroke scale,NIHSS was used to evaluate the neurological function in early clinical disease progress Compared between different groups.Results: 150 patients were enrolled,among them 106 patients with PPI-BAS(70.7%),44 patients with PPI +BAS(29.3%),48 patients with d PPI(32%),102 patients with v PPI(68%);41 patients with d PPI-BAS(27.3%),65 patients with v PPI-BAS(43.3%).1.Compared to patients with PPI-BAS,patients with PPI + BAS more likely with coronary heart disease(P=0.045),diabetes(P=0.041),ICAS(P=0.005),EAAS(P=0.012),v PPI(P=0.006),basal artery high signal(P=0.033)and ≥2 layer infarcts(P=0.015).Patients with PPI + BAS less likely with hypertension(P=0.012),with lower median LA(P=0.010)and LI(P=0.021)classification.Patients with PPI + BAS more likely had early disease deterioration.Diabetes and ≥2 layer infarcts were independent prognostic factors for PPI + BAS(OR = 2.461,95% CI: 1.028 ~ 5.895)and(OR = 2.531,95% CI: 1.019 ~ 6.285),LA prompt that PPI + BAS was caused by small vessel disease(OR = 0.538,95% CI: 0.303 ~ 0.956).2.Compared to patients with d PPI,patients with v PPI more likely with coronary heart disease(P=0.005),ICAS(P=0.000),EAAS(P=0.000),basal artery stenosis(P=0.006),basal artery high signal(P=0.018),and≥2 layer infarcts(P=0.000).Patients with v PPI less likely with hypertension(P=0.005),with lower median LA(P=0.000)and LI(P=0.000)classification.Patients with v PPI more likely had early disease deterioration(P=0.000).Basal artery high signal and≥2 layer infarcts were independent prognostic factors for v PPI(OR = 5.736,95% CI: 1.516 ~ 21.702)and(OR= 7.228,95% CI: 1.586 ~ 32.946);LA and LI prompt that v PPI was caused by small vessel disease(OR = 0.515,95% CI: 0.295 ~ 0.900)and(OR = 0.263,95% CI: 0.093 ~0.741).3.The three groups: The prevalence of coronary heart disease,diabetes,ICAS,EAAS,basal artery high signal,≥2 layer infarcts,early disease progression,hypertension,median LA and LI classification were no difference between patients with v PPI-BAS and patients with PPI + BAS.Compared patients with d PPI-BAS,patients with PPI + BAS more likely with coronary heart disease(P=0.005),diabetes(P=0.013),ICAS(P=0.001),EAAS(P=0.001),basal artery high signal(P=0.018)and ≥2 layer infarcts(P=0.002).Patients with PPI + BAS less likely with hypertension(P=0.005),with lower median LA(P=0.000)and LI(P=0.000)classification.Patients with PPI +BAS more likely had early disease deterioration(P=0.013).EAAS and ≥2 layer infarcts were independent prognostic factors for PPI + BAS(OR= 4.977,95% CI: 4.977 ~23.091)and(OR= 11.501,95%CI:1.639~80.685,P=0.014).LA prompt that PPI +BAS was caused by small vessel disease(OR= 0.367,95% CI: 0.367 ~ 0.650).Compared patients with d PPI-BAS,patients with v PPI-BAS more likely with ICAS(P=0.000),EAAS(P=0.001)and ≥2 layer infarcts(P=0.002).Patients with v PPI-BAS less likely with hypertension(P=0.005),with lower median LA(P=0.000)and LI(P=0.000)classification.Patients with v PPI-BAS more likely had early disease deterioration.≥2 layer infarcts was an independent prognostic factor for v PPI-BAS(OR = 6.438,95% CI: 6.438 ~ 40.756);LA and LI prompt that v PPI-BAS was caused by small vessel disease(OR =0.458,95% CI: 0.458 ~ 0.827)and(OR= 0.186,95% CI:0.186 ~ 0.605).Conclusion: PPI patients with basilar artery stenosis more likely with vPPI.PPI patients without basilar artery stenosis have different pathogenesis: PPI Patients without involving the pons ventral surface more likely with mechanism of small vessel disease,PPI Patients with involving pons ventral surface more likely with mechanism of atherosclerosis,and had the potential risk of early disease deterioration.