Risk factors and prognosis of early neurological deterioration in patients with posterior circulation cerebral infarction

Abstract

Abstract Background: The incidence, risk factors, and pathogenesis of early neurological deterioration (END) in posterior circulation stroke are still unclear. In this study, we aimed to determine the risk factors and prognosis of END in patients with acute posterior circulation cerebral infarction. Methods: Acute posterior circulation ischemic stroke patients who had completed neuroimaging within 72 hours of onset were selected from a prospective registry study. Demographic characteristics, physiological data, medical history, laboratory data, in-hospital evaluation, neurological severity and TOAST classification, treatment, and the modified Rankin Scale (mRS) score of patients were assessed. Early neurological deterioration was defined as an increase of ≥2 points in the National Institutes of Health Stroke Scale score between the baseline and 72-hour evaluation. Favorable and poor outcomes were defined as mRSs of 0–2 and ≥3, respectively, at 3 months. The incidence and risk factors were evaluated by univariate and multivariate regression analysis (step-back method). Results: The analysis included 455 subjects with an acute posterior circulation non-cardiac ischemic stroke, 330 (72.53%) of them male, with an average age of 63.12 (±10.14) years and with 47 (10.33%) having END. The results of univariate and multivariate logistic regression analysis showed that BATMAN scores ≥5 (OR: 0.1, 95% CI: 0.02–0.53, P < 0.01), large artery atherosclerosis (OR: 11.55, 95% CI: 4.18–31.93, P < 0.01), vascular stenosis >50% (OR: 2.44, 95% CI: 1.1–5.42, P = 0.029), reperfusion therapy (OR: 4.21, 95% CI: 1.66–10.64, P < 0.01), and the distribution of pontine lesions (OR: 5.66, 95% CI: 2.39–13.44, P< 0.01) were significantly associated with END. Patients with END had a lower rate of favorable outcomes at discharge and long-term follow-up (P < 0.001), regardless of whether they received reperfusion therapy. Conclusion: The lesion distribution of the pons, the progression of temporo-occipital lobe lesions, and large arterial atherosclerosis are independent risk factors of END that might predict a poor short- and long-term prognosis.