Anterior Cerebral Artery Infarction: Infarct Pattern Establishment And Clinical-imagining Feature Analysis In 107 Patients

Objective:To establish the anterior cerebral artery(ACA) infarct patterns and analyze the clinical-imaging features, thus provide theoretical basis for better identification of the clinical pathogenetic mechanisms. Methods:Information of acute solitary ACA infarction(ACAI) patients admitted to department of neurology, the First Hospital of Shanxi Medical University from May 1, 2012 to April 30, 2015 was collected and cleaned, thus obtained the final information, including sex-age, riskburden, retrospective National Institute of Health Stroke Scale(rNIHSS) rank, Modified Rankin Scale(mRS) rank, hospital rehabilitation and infarct etiologies. Two infarct patterns(IPs) are defined as IP 1 and IP 2. IP 1 is classified into 5 classes as cortex isolated lesion, deep isolated lesion, continuous lesion, non-continuous lesions at multiple sites, and multiple lesions at the single site, which depends on lesion morphology as well as location. IP 2 is a lesion location dependent definition, which classified the ACA IP into 4 categories, as cortex lesion, subcortex lesion, callosum lesion and multiple sites lesions. Constituent ratio was adopted for description of demography and clinical-imaging characteristics, and optical scaling for corresponding relationship between basic information as well as clinical-infarct patterns. Results:1.A total of 117 stroke patients accord with definition of acute solitary ACAI were observed, accounting for 3.28% of the total hospitalized patients with acute ischemic stroke of the corresponding period;2. Motor dysfunction and speech disorders are the most common dominant symptoms of ACAI, with ACA local atherosclerotic stenosis or occlusion as the main etiological mechanism;3. While most ACA infarction patients are burdened with high risk, the vast majority suffered mild-to-moderate neuro-functional impairment, which account for 96.2%. When comes to hospital rehabilitation, 40.2% of patients come out with no better even worse. Although the prognosis for most patients is good, there are still 25.2% of patients come out incapable of self-dependence.4. After multiple correspondence analysis of clinical basic information, the standardized discrimination measure shows a widely existed relevance between all these basic information, including sex-age, riskburden, rNIHSS rank, mRS rank, hospital rehabilitation. There are important correlation between rNIHSS rank and mRS rank, with a correlation coefficient of 0.755. The association between rNIHSS rank and riskburden is not that close as expected, with a correlation coefficient of 0.082.5. The standardized discrimination measure of multiple correspondence analyses for clinical-IP 1 demonstrated a relatively high relevance between IP 1 and infarct etiologies, with a correlation coefficient of 0.687. Class point association graph suggested that elderly men with cortex lesions tend to be cardiogenic embolism; young and middle-aged men and older women with non-continuous lesions of multiple sites may be due to combined mechanisms; young and middle-aged male with multiple risk factors could cause multiple lesion at the single site for artery to artery embolism; the middle and old aged men with medium risk factors may get deep isolated lesions caused by perforator artery disease or local branch occlusion caused by parent artery plaque; although risk factor burden on young men and middle-aged women is not that heavy, the seldom continuous lesions caused by in situ thrombosis may induce severe stroke.6. The standardized discrimination measure of multiple correspondence analyses for clinical-IP 2 also showed a high relevance between IP 2 and infarct etiologies, with a correlation coefficient of 0.574. Class point association graph demonstrated that middle and old aged women, young men and older men with multiple lesion prone to be moderate stroke induced by combined mechanisms; in situ thrombosis is associated with severe stroke; medium riskburden patients may get subcortex lesion or callosum lesion caused by perforator artery disease or local branch occlusion; middle-aged men burdened with heavy risk factors often cause mild stroke, with artery-to-artery embolism the possible mechanism; the elderly men with light riskburden tend to be cortex lesions, which may be caused by cardiogenic embolism.7. The multiple correspondence analyses involved two infarct patterns showed that both of the IPs have high relevance with infarct etiologies, with correlation coefficient of 0.715 and 0.594, respectively. There is also high consistency between these two IPs, with a correlation coefficient of 0.755. However, the relevance between IP 1 and etiologies is higher than that between IP 2 and etiologies. Conclusion:The infarct pattern contributes to identification of etiology mechanisms of ischemic stroke. The infarct pattern depends on location as well as lesion morphology is better than that based on location alone.