Risk Factors Of Neurological Deterioration In Patients With Acute Cerebral Infarction In The Territory Of Middle Cerebral Artery

Objective Neurological deterioration(ND)is common in patients with acute cerebral infarction(ACI),which is closely associated with the short-term and long-term outcome.The purpose of this study was to explore the risk factors of ND in patients with ACI in the territory of middle cerebral artery(MCA),in order to provide reference for early clinical treatment.Methods Patients with ACI in unilateral MCA territory admitted within 7 days of onset were continuously recruited,and the stenosis of MCA M1 segment was evaluated by magnetic resonance angiography(MRA).The occurrence of ND was observed within 2 weeks after onset,and the patients were divided into ND group and non-ND group.In patients of ACI and those of ACI with coexisting MCA M1 stenosis,the demographic data,clinical data,etiological classification and imaging data were compared separately between ND group and non-ND group.Results 1.A total of 237 patients with ACI in the MCA territory were enrolled,including 62 patients of ACI with MCA M1 stenosis ? 50%.The median age of all patients was 66(59,77)years old.There were 160 males and 77 females.In all patients with ND,the median time from onset to ND was 2 days(interval from 0.25 to 10 days).ND occurred within 1 day of onset in 11 patients(29.73%),within 1-2 days in 9 patients(24.32%),within 2-3 days in 8 patients(21.62%),within 3-7 days in 7 patients(18.92%),and within 7-14 days in 2 patients(5.41%).2.Among the patients with ACI in the MCA territory,there were 200 patients(84.39%)in non-ND group and 37 patients(15.61%)in ND group.Compared with the non-ND group,the rate of previous stroke or TIA history(P=0.025)was lower,and the time interval from onset to admission(P < 0.001)was shorter,while the admission systolic blood pressure(P=0.009)was higher,total cholesterol level(P=0.003)and low density lipoprotein cholesterol(LDL-C)level(P=0.002)were higher,and the maximum infarction diameter(P=0.004)was larger in the ND group.The results of multivariate logistic regression analysis showed that higher systolic blood pressure(OR=1.39,95%CI:1.01?1.92,P=0.047),shorter interval from onset to admission(OR=0.96,95%CI:0.93?0.99,P=0.002),and higher LDL-C level(OR=1.75,95%CI:1.04?2.94,P=0.035)were independently correlated with ND among the patients with ACI in the MCA territory.3.Among the ACI patients with MCA M1 stenosis? 50%,there were 49 patients(79.03%)in non-ND group and 13 patients(20.97%)in ND group.Compared with the non-ND group,the time interval from onset to admission(P=0.002)in the ND group was shorter.Multivariate logistic regression analysis showed that previous stroke or TIA history(OR=0.13,95%CI:0.02?0.84,P=0.032),higher admission systolic blood pressure(OR=2.60,95%CI:1.11?6.09,P=0.028),shorter interval from onset to admission(OR=0.96,95%CI:0.92?0.99,P=0.023 and stenosis length of ?8mm(OR=8.52,95%CI:1.15?62.88,P=0.036)were independently associated with ND among the ACI patients with MCA M1 stenosis? 50%.Conclusions 1.The incidence of ND within 2 weeks of symptom onset in patients with acute ACI in the MCA territory was 15.61%.2.Higher systolic blood pressure,shorter time interval from onset to admission and higher LDL-C level were independent risk factors of ND in patients with ACI in the MCA territory.In addition,no previous stroke or TIA history and longer MCA M1 stenosis length also were independent risk factors of ND in ACI patients with MCA M1 stenosis? 50%.