Cavitation of symptomatic acute single small subcortical infarctions
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ORIGINAL ARTICLE
Cavitation of symptomatic acute single small subcortical infarctions Xin Zhang 1,2 & Yonggui Ge 1,3 & Caihong Liang 1,2 & Yujie Wang 1 Received: 20 March 2020 / Accepted: 30 May 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Background and purpose To investigate cavitation of symptomatic acute single small subcortical infarctions (SSSI). Methods Acute SSSI were diagnosed with magnetic resonance (MR) diffusion-weighted imaging (DWI) combined with apparent diffusion coefficient (ADC) sequence on follow-up MR imaging. Cavitation of the acute SSSI was comprehensively viewed on FLAIR, T2-, and T1-weighted sequences. Results We enrolled 123 patients with acute SSSI. The follow-up median interval was 303 (125–390) days. The lesions of SSSI evolved into cavitation in 93 patients (75.6%), evolved into WMHs in nine patients (7.3%), and were no visible in 21 patients (17.1%). Cavitation was independently associated with larger infarct diameter on baseline DWI [odds ratio (OR), 1.250, 95% CI (1.078–1.451), P = 0.003], higher score of baseline old lacunar infarct [OR 3.44, 95% CI (1.49–7.91), P = 0.004], and lower rate of dyslipidemia [OR 0.30, 95% CI (0.10–0.76), P = 0.013]. Conclusion Cavitation occurred more in the setting of small vessel diseased brain and less in the SSSI of possible atherosclerotic etiology. This suggested that the etiology of infarct was associated with cavitation after acute SSSI. Keywords Cavitation . Acute SSSI . Lacunar infarct
Introduction Old lacunar infarct was one of the imaging markers of small vessel disease. As early as 10 years ago, it has been reported that not all the acute lacunar infarcts evolved into old lacunar infarcts (defined as “cavitation”), where only about 25% acute lacunar infarcts evolved into lesions of cavity, the others
* Yujie Wang [email protected]; [email protected] Xin Zhang [email protected] Yonggui Ge [email protected] Caihong Liang [email protected] 1
Cerebrovascular Disease Center, Department of Neurology, People’s Hospital, China Medical University, 33 Wenyi Road, Shenhe District, Shenyang 110016, People’s Republic of China
2
China Medical University, 77 Puhe Road, Shenyang North New Area, Shenyang 110122, People’s Republic of China
3
Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian 116044, People’s Republic of China
evolved into lesion of white matter hyperintensities (WMHs) [1]. The results suggested the possible relationship between acute lacunar infarct and WMHs, an under-recognized possible mechanism of WMHs. Shortly afterwards, other results of studies were reported on the topic [2–4]. The issue has been studied up till now [5–8]. Although the rate of cavitation varied from 25 to 94% [1–8], there was a consensus that not all acute lacunar infarcts evolved into cavity, some of them evolved into WMHs. And some of the lesions of acute lacunar infarcts were even no longer visible on follow-up imaging [4]. This reminds us that the history of stroke should be asked even
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