Clinical Imaging Prediction Of Early Neurological Deterioration With Acute Cerebral Infarction Confirmed By Head MRI In The Middle Cerebral Artery Blood Supply Area

Objective: To investigate the clinical imaging predictors of early neurological deterioration(END)in the acute cerebral infarction confirmed by head MRI of the middle cerebral artery(MCA)blood supply area.Methods: 258 Patients with acute cerebral infarction in the middle cerebral artery blood supply area confirmed by MRI examination were enrolled in the first Department of Neurology,People's Hospital of Liaoning Province from September2016 to August 2018.According to the inclusion and exclusion criteria,110 patients were finally included in the study.According to the NIHSS score,the early deterioration of neurological deficits in the early stage of stroke was divided into END group and non-END group.END was defined as an increase in the National Institue of Health Stroke Scale(NIHSS)score ?4 at any time within the first 72 h after adminission or the motor score of NIHSS ? 2 within 5 d after adminission compared with the baseline.The clinical baseline characteristics,laboratory data,and imaging data were compared between the END group and the non-END group.Multivariate logistic regression was used to analyze the correlation between infarction site of the middle cerebral artery supply area(pial infarcts,internal border-zone infarcts,basal ganglia infarcts,territorial infarcts),ICA and MCA stenosis severity of both sides(no or mild: stenosis <50%;moderate to severe stenosis: stenosis 50-99%;occlusion: 100% stenosis)and END Results: There were 258 patients with acute cerebral infarction in the middle cerebral artery blood supply area.According to the admission criteria,110 patients were included in the study.34 patients(30.9%)had early neurological deterioration,and 30patients(88.3%)occurred within 72 hours after stroke,another 4(11.7%)occurred within 72 hours to 5 days after stroke.Univariate analysising the patients with END and non-END groups,there were significant diferences in the systolic blood pressure at admission(P=0.004),initial NIHSS score at admission(P=0.001),and the consituent ratios of previous history of hypertension(P=0.034),initial NIHSS score?8 at admission(P=0.010),basal ganglia infarction(P=0.005),internal border-zone infarction(P=0.018),regional infarction(P=0.010),ipsilateral MCA stenosis50%-99% or occlusion(P<0.001)and ipsilateral ICA stenosis 50%-99% or occlusion(P<0.001).Multivariate logistic regression analysis showed that systolic blood pressure of patients at admission(OR=1.026,95% CI: 1.000-1.052,P=0.049),internal border-zone infarction(OR=10.034,95% CI: 1.665-60.473,P= 0.012)at DWI,the ipsilateral middle cerebral artery stenosis 50%-99%(OR=6.414,95% CI:1.438-28.614,P=0.015),occlusion(OR=8.627,95% CI: 1.047-71.094,P=0.045),and ipsilateral internal carotid artery stenosis 50%-99%(OR=5.145,95% CI:1.296-20.426,P=0.020)were independent risk factors for patients occuring END after acute cerebral infarction in the middle cerebral artery supply area.Conclusions:1.Early neurological deterioration of MCA blood supply area acute cerebral infarction more occurs within 72 hours after stroke.2.Systolic blood pressure at admission and internal border-zone infarction showed in DWI were independent risk factors for early neurological deterioration in acute cerebral infarction in the MCA supply area.3.Cerebral infarction lesions with ipsilateral MCA stenosis 50%-99%,occlusion and ipsilateral ICA stenosis 50%-99% are independent predictors of END after acute cerebral infarction in the middle cerebral artery supply area,and the severity of middle cerebral artery stenosis,the higher the risk of END.Non-responsible blood vessels,ie,the contralateral MCA and ICA stenosis were not significantly associated with END.