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The progressive course of neurological symptoms in anterior choroidal artery infarcts.
MedLine Citation:
PMID:  23294991     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Infarctions of the anterior choroidal artery affect multiple anatomical structures, leading to a wide spectrum of neurological deficits with frequent symptom fluctuation or progression. AIMS: To assess etiological mechanisms, frequency, and predictors of symptom progression, as well as its impact on prognosis. METHODS: Anterior choroidal artery infarct patients were prospectively identified via predefined infarct locations with ischemic lesions ≥1·5 cm vertical diameter in cerebral imaging. Definition of neurological progression was ≥2 National Institutes of Health Stroke Scale points in motor function or ≥4 in total National Institutes of Health Stroke Scale. Stroke etiology was determined according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. We assessed demographical data, risk factors, and acute phase parameters in order to find predictors of neurological progression. RESULTS: Thirty patients fulfilled the inclusion criteria. Eighteen patients (60%) had neurological progression during days 1-3. Despite similar stroke severity at admission (median National Institutes of Health Stroke Scale in progressive infarcts 4·5 versus 4; P = 0·72), patients with progression had more severe deficits at day 3 (median National Institutes of Health Stroke Scale 9 vs. 3·5; P = 0·04) and worse three-month outcome. Only 31% of patients with progression scored <2 in the modified Rankin Scale compared with 89% without progression (P = 0·01) after three-months. No statistically significant differences regarding possible predictors of progression were found. Magnetic resonance imaging findings and etiological assessment suggest overlapping mechanisms of small and large vessel disease. CONCLUSIONS: Neurological deterioration is frequent in anterior choroidal artery infarcts and is associated with worse outcome. While mechanisms of small and large vessel disease seem to overlap in anterior choroidal artery infarction, we were not able to identify predictors of neurological progression.
Authors:
Sabine Derflinger; Jochen B Fiebach; Stefanie Böttger; Roman L Haberl; Heinrich J Audebert
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-7
Journal Detail:
Title:  International journal of stroke : official journal of the International Stroke Society     Volume:  -     ISSN:  1747-4949     ISO Abbreviation:  Int J Stroke     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101274068     Medline TA:  Int J Stroke     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.
Affiliation:
Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, München, Germany.
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