Objective :
To evaluate the role of cortical cerebral microinfarcts (CMIs), identified on a 3T magnetic resonance imaging (MRI) at the acute phase of an ischemic stroke, on the functional outcome after stroke.
Method:
We retrospectively recruited 62 patients with first-ever ischemic stroke during the period of April, 2019 through April, 2020. All patients undergoing 3.0T MRI were included and enrolled inpatient referred to our rehabilitation department within 6 months of onset. Cortical CMIs were assessed on a brain 3T MRI realized at baseline. Cortical CMIs were defined as only intracortical lesions <5mm in diameter, appearing in hyposignal on T1-wi and hyper or isosignal on FLAIR sequences (Fig 1). Clinical and functional parameters were recorded by medical records including demographics, hypertension, dyslipidemia, diabetes mellitus (DM), history of smoking, days since stroke onset and a National Institutes of Health Stroke Scale score (NIHSS), as well as Korean version of the Mini-Mental Status Examination (K-MMSE), the Berg balance scale (BBS) and functional independence measure (FIM) score. Radiologic factors identified the location of the right, left, and bilateral lesions, and other lesions were also confirmed. Among them, patients with prestroke dementia or prestroke neurological disability were excluded from the study. Partial correlation and multiple lin.ear regression were used to analyze the correlation between cortical CMIs and functional outcomes. Data analyses involved use of SPSS v18.0 for Windows. P < 0.05 was considered statistically significant.
Results :
Vascular risk factors associated with the number of cortical CMIs are presented in Table 1. In multivariate analysis, age and NIHSS were the independent cardiovascular risk factor associated with the number of cortical CMIs (P=0.013, P=0.022). The results of partial correlation and multiple linear regression analyses between the number of cortical CMIs and cognitive and functional parameters including MMSE, BBS and FIM score in Table 2. In multivariate analyses, the number of cortical CMIs remained significantly associated with MMSE and functional outcome parameters (BBS, FIM) after ischemic stroke. (P=0.006, P=0.0001, P=0.002).
Conclusion :
Cortical CMIs is a radiological marker associated with worse performances and slowed down improvement of functional outcomes as well as cognitive recovery following ischemic stroke.
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Fig 1. Example of cortical cerebral microinfarcts (CMIs) detected on 3T brain magnetic resonance imaging (MRI). The cortical CMIs were detectable as a hyposignal on T1-wi, as a hypersignal on Fluid Attenuated Inversion Recovery (FLAIR) sequences, and as an isosignal on susceptibility weighted imaging.
Table 1. Demographic and Cardiovascular Predictors of the Number of Cortical Cerebral microinfarcts
Table 2. Partial Correlation Coefficient(r) and Multiple Linear Regression Adjusted for Age, Sex, Hypertension, Dyslipidemia, DM, Smoking, Lesion Laterality, Onset Duration and National Institutes of Health Stroke Severity (NIHSS) between the CMIs and Functional Outcomes (n=62)
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