BACKGROUND: Early neurological deterioration (END) is not uncommon in lacunar stroke and may lead to poor outcome. Several predictors for END have been previously reported, however, well-designed, MRI-based studies are rare in lacunar stroke. We prospectively enrolled consecutive patients with acute lacunar infarct (≤ 48 h) confirmed by MRI to investigate possible predictors for END. METHODS: Demographic data, vascular risk factors, laboratory findings, and neurological status were obtained. END was defined as an increment of the National Institutes of Health Stroke Scale (NIHSS), ≥ 1 in motor power, or ≥ 2 in any scores during the first week. RESULTS: A total of 131 patients were recruited and 17 (13%) developed END after admission. Univariate analysis revealed that diabetes, systolic blood pressure, triglyceride (TG), total cholesterol, low density lipoprotein-cholesterol, and homocysteine were associated with END. After multiple logistic regression analysis, the highest quartile of TG level (>145 mg/dL) remained independent [adjusted odds ratio (OR) = 11.46, 95% confidence interval (CI) = 1.07-122.87, P = 0.044]. CONCLUSION: Hypertriglycedemia may be a possible predictor for END in acute lacunar stroke. Thrombogenecity and microcirculatory disturbance augmented by hypertriglyceridemia may be suggested as potential mechanisms. Further studies are warranted to confirm these results. Pathophysiological and therapeutic considerations remain to be determined.
BACKGROUND: Early neurological deterioration (END) is not uncommon in lacunar stroke and may lead to poor outcome. Several predictors for END have been previously reported, however, well-designed, MRI-based studies are rare in lacunar stroke. We prospectively enrolled consecutive patients with acute lacunar infarct (≤ 48 h) confirmed by MRI to investigate possible predictors for END. METHODS: Demographic data, vascular risk factors, laboratory findings, and neurological status were obtained. END was defined as an increment of the National Institutes of Health Stroke Scale (NIHSS), ≥ 1 in motor power, or ≥ 2 in any scores during the first week. RESULTS: A total of 131 patients were recruited and 17 (13%) developed END after admission. Univariate analysis revealed that diabetes, systolic blood pressure, triglyceride (TG), total cholesterol, low density lipoprotein-cholesterol, and homocysteine were associated with END. After multiple logistic regression analysis, the highest quartile of TG level (>145 mg/dL) remained independent [adjusted odds ratio (OR) = 11.46, 95% confidence interval (CI) = 1.07-122.87, P = 0.044]. CONCLUSION: Hypertriglycedemia may be a possible predictor for END in acute lacunar stroke. Thrombogenecity and microcirculatory disturbance augmented by hypertriglyceridemia may be suggested as potential mechanisms. Further studies are warranted to confirm these results. Pathophysiological and therapeutic considerations remain to be determined.