Background:
The association between early neurologic deterioration (END) in pontine infarction and basilar stenosis remains unclear. Recently, it has been reported that evaluation of the basilar artery using high-resolution MRI (HRMRI) could provide more accurate information about intracranial artery stenosis than MR angiography (MRA). We aimed this study to identify the relationship between basilar plaque assessed by HRMRI and END after pontine infarction.
Methods:
Ninety consecutive patients with unilateral pontine infarction within 24 hours of stroke onset were included. All patients underwent diffusion weighted MRI, MRA and HRMRI within 24 hours after admission. Basilar stenosis was assessed with MRA and HRMRI. Basilar plaque on HRMRI was classified as 1) "no plaque" when the wall of the basilar artery was clear; 2) "minimal plaque" when the basilar wall was irregular without clear crescentic thickening; and 3) "apparent plaque" when a typical lesion with a crescentic thickening of the wall could be seen. END was defined as increased NIHSS score by ≥2 during admission. Factors potentially associated with END were validated by multivariate analyses.
Results:
Sixty-six patients (73%) had paramedian pontine infarction (PPI) and 24 patients (27%) had deep pontine infarction (DPI). END was observed in 29 (32%) patients and they all had PPI. Patients with END had more frequent apparent plaque in basilar artery than without it (79% versus 33%, p=0.001). However, basilar stenosis (>30%) assessed by MRA did not show any differences regardless of the presence of END (24% versus 17%, p=0.380). In univariate analysis with the patients with PPI, END was associated with hypertension (p=0.029) and apparent plaque (p=0.002). After adjusting covariates, END was independently associated with hypertension (OR, 6.672; 95% CI, 1.376-32.367) and apparent plaque (OR, 7.260; 95% CI 1.285-41.030).
Conclusion:
Our result suggest that basilar stenosis assessed by HRMRI was associated with END in patients with acute pontine infarction. However, the result was not significant when assessed by MRA. We suggest that since basilar stenosis are underestimated with MRA, HRMRI may be more useful in evaluating basilar artery stenosis and predicting END in pontine infarction.
What drives progressive motor deficits in patients with acute pontine infarction?
