The Study Of Clinical Characteristics And Its Mechanism Of Single Acute Infarction Located In Basal Ganglia Region

[Objective]Comparative analysis for clinical characteristics and its mechanism of single acute infarction with various diameters located in basal ganglia region.[Methods]All144patients with single acute infarction located in basal ganglia region were recruited in this study retrospectively. All patients had brain and neck magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) within72h after onset. They were divided into three groups:(1) Lacunar Infarcts, LI (n=60, maximal diameters<1.5cm);(2) Branch Atheromatous Disease, BAD (n=60, maximal size of infarctions in diameters were from1.5cm to3cm) and (3) Striatocapsular Infarction, SCI (n=24, maximal diameters>3cm) based on the maximal diameters of the infarctions on diffusion weighted imaging (DWI). The clinical features were compared among the three groups. Dynamic national institutes of health stroke scale (NIHSS) in7days after the admission were evaluated, and analyzed by multiple logistic regression to estimate the independent contribution of the risk factors to the early progressive motor deficits. Then, each of three groups was subdivided into five subgroups according to the MRA and clinical symptoms, to investigate the stroke mechanism.[Results]1. clinical features:Pure motor hemiparesis is one of the most common lacunar syndrome in LI (23/60, 38.3%),5(5/60,8.3%) of60patients revealed early progressive motor deficits;19(19/60,31.7%) of60patients revealed early progressive motor deficits in BAD, and most patients (8/19,42.1%) appeared early progressive motor deficits within24h after onset;14(14/24,58.3%) of24patients revealed cortical symptoms, aphasia (12/14,85.7%) is one of the most common feature in SCI;18(18/24,75.0%) of24patients appeared unequal paralysis;8(8/24,33.3%) of24patients revealed early progressive motor deficits.2. early progressive motor deficits:The proportion of early progressive motor deficits among three groups was statistical significance (X2=11.507, P<0.05). The proportion of the patients with early progressive motor deficits in BAD was significantly higher than that in LI (19/60vs.5/60, X2=10.208, P<0.05); The proportion of early progressive motor deficits between BAD and SCI was no statistical significance (X2=0.22, P>0.05); The proportion of the patients with early progressive motor deficits in SCI was significantly higher than that in LI (8/24vs.5/60, X2=6.391, P<0.05).3. the risk factors associated with early progressive motor deficits: By multiple logistic regression analysis, elevated systolic blood pressure on admission (odds ratio (OR)5.42,95%confidence interval (CI)1.507-10.063, P=0.016) was independently related to early progressive motor deficits in BAD; NIHSS on admission was risk factors for early progressive motor deficits in SCI (t=-2.236, P=0.036).4. vascular etiologies:5(5/60,8.3%) of60patients had relevant intracranical large artery disease (Middle Cerebral Artery lesions, MCA)in LI;24(24/60,40.0%)of60patients had relevant intracranical large artery (MCA) disease in BAD;13(13/24,54.1%) of24patients had relevant intracranical large artery disease,9of13was MCA lesions;4of13was internal carotid artery (ICA) lesion in SCI. Compared vascular stenosis between MCA and ICA was no statistical significance (U=14.00, P>0.05). The proportion of intracranical large artery disease among three groups was statistical significance (X2=23.550, P<0.05). The proportion of the patients with intracranical large artery disease in BAD was significantly higher than that in LI (24/60vs.5/60, X2=16.886, P<0.05); The proportion of the patients with intracranical large artery disease in SCI was significantly higher than that in LI(13/24vs.5/60, X2=21.398, P<0.05); The proportion of intracranical large artery disease between BAD and SCI was no statistical significance (X2=1.256, P>0.05). Compared vascular stenosis between BAD and SCI was statistical significance (U=86.00, P<0.05).[Conclusions]1. Three groups had different clinical features:pure motor hemiparesis is one of the most common lacunar syndrome in LI; Patients in SCI revealed unequal paralysis and cortical symptoms, aphasia is one of the most common feature; Patients in SCI and BAD tended to early progressive motor deficits.2. Elevated systolic blood pressure upon admission is the most significant independent factor related to early progressive motor deficits in BAD; NIHSS on admission is the risk factors for early progressive motor deficits in SCI.3. Three groups had different stroke mechanism:The pathogenic mechanism of BAD and SCI may be associated with intracranical large artery disease; There is a significant correlation between stensis of intracranical large artery and the infarction with different diameters.