뇌미세혈관병증 3가지 표식과 열공뇌경색 초기 신경학적 …

1 J Korean Neurol Assoc Volume 30 No. 4, 2012 267 3 , Association of 3 Stigmas of Cerebral Microangiopathy With Early Neurological Deterioration in Lacunar InfarctionJangsup Moon, MD, Nayoung Kim, MD, Jihoon Kang, MD, Mi Hwa Yang, MD, Myung Sook Jang, MD, Moon-Ku Han, MD, Hee-Joon Bae, MDDepartment of Neurology, Stroke Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, KoreaBackground: Neurological deterioration following acute lacunar infarction is not uncommon. Its association with poor clinical outcome is well-known, but little is known about what causes it. This study aimed to elucidate whether 3 stigmas of cerebral microangiopathy, a pathogenesis of lacunar infarction, are associated with neurological deterioration in patients with acute lacunar : Patients with acute lacunar infarction who were admitted within 24 hours of onset were identified using a prospective stroke registry.

2 Patients who presented neurological deterioration within 7 days of hospitalization (progressive lacune group) were matched to 4 controls (non-progressive lacune group) for onset to arrival time . Three stigmas of cerebral microangiopathy (leukoaraiosis, cerebral microbleeds, and silent lacunes) were measured using initial brain MRI, and their associations with neurological deterioration were : During 45 months, a total of 23 patients were identified and matched to 80 controls. Simple comparison of 2 groups showed that those 3 stigmas of cerebral microangiopathy were not significantly associated with neurological deterioration. Hyperlipidemia (p= ), history of transient ischemic attack or stroke (p= ), initial NIH stroke scale (p= ), white blood cell counts (p= ), and lesion volume (p= ) were possibly different (p s< ) between 2 groups. Multivariable logistic regression analysis did not reveal any significant association of those 3 stigmas with neurological deterioration, too (all p values> ).

3 Conclusions: This study did not find a relationship between cerebral microangiopathy and neurological deterioration following acute lacunar infarction. The possibility of inadequate power should be Korean Neurol Assoc 30(4):267-273, 2012 Key Words:Cerebral microangiopathy, Cerebral small vessel disease, Lacunar infarction, Neurological deterioration, Progressive strokeReceived September 10, 2012 Revised September 20, 2012 Accepted September 20, 2012 Hee-Joon Bae, MDDepartment of Neurology, Stroke Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 463-707, KoreaTel: +82-31-787-7467 Fax: +82-31-787-4059E-mail: ( : A102065). 25% (lacunar infarction) ,1 12-36% .2 , .3,4.

4 (neurological deterioration) 268 30 4 , 2012Fi gure. Patients selection. SNUBH: Seoul National University Bundang Hospital, FAT: first abnormal time, MRA: magnetic resonance angiography, CTA: computed tomography angiography, TFCA: transfemoral cerebral angiography..5-12 , , NIHSS score, , , . (microatheroma) (lipohyalinosis) .13,14 , (cerebral micro-angiopathy, cerebral small vessel disease) (stigma) , . (leukoaraiosis), (cerebral mi-crobleeds), (silent lacunar infarction) ,15 .16,17.

5 1. 2007 7 2011 3 (Magnetic resonance Image, MRI) , 20 mm , 24 . (first abnormal time) . , 2-5 .18-20 24 . (MR angiography), (CT angiography) (transfemoral cerebral angiography) . 1 (progressive la-cune group), (non-progressive lacune group) . 1:4 . 23 80 (Fig.).2. , , ( , , , , , ), ( , NIHSS (prospective stroke registry).)

6 21 , (clinical data warehouse) . Trial of Org 10172 in Acute Stroke Treatment (TOAST) .22 3 J Korean Neurol Assoc Volume 30 No. 4, 2012 2692007 7 . 1 (Yang MH) , , . (1) NIHSS 2 , (2) NIHSS 1 , (3) NIHSS 1 , (4) , , . , . (diffusion-weighted MRI).

7 3. Tesla , (Moon J) . , , (Kim N) . (fluid-attenuated in-version recovery, FLAIR) Fazeka .23 , FLAIR 3 mm .24 (gradient echo imaging) 5 mm .25 MIPAV (Johns Hopkins MedIC, ) .4.. T (independent t-test) Mann-Whitney U test , (chi- square test) . Fazeka 0, 1 , 2, 3 , . 0 , 1 , 2 . , .. p<.

8 Overfitting . (backward elimination and stepwise regression) (Wald statistics) , . (multivariate logistic regression) , 95% , p . SPSS (version , SPSS Inc, Chicago, IL) , .. , , .24 , (odds ra-tio, ) .16 50% 1:4 23 92 61% . nQuery advisor (version , Statistical 270 30 4 , 2012 Tabl e 1.)

9 Comparison of demographics and clinical characteristics between progressive lacune and non-progressive lacune groups Progressive lacuneNon-Progressive lacune (unmatched)Non-Progressive lacune (matched) n=23n=199p valuen=80p valueAge , maleb 11 ( )120 ( ) ( ) 9 ( )126 ( ) (45%) 3 ( )57 ( ) (25%) 9 ( )42 ( ) ( ) 11 ( )92 ( ) (40%) history of TIA or strokeb 10 ( )43 ( ) ( ) MRS 2b 2 ( )18 (9%) 4 (5%) to admission,c min165 (86-433)*354 (112-758)* (64-408)* to MRI,c min196 (128-574)*-- 196 (114-452)* at admissionc 4 (2-5)*3 (1-4)* 2 (1-5)* volume,c cc589 (422-870)*-- 427 (194-822)* / , % , 103/ , , % cholesterol, , , , , , , INR , , variables are expressed as number (percentage) whereas continuous variables are expressed as mean SD or *median (interquartile range).

10 AIndependent t-test was performed. bChi-square test was performed. cMann-Whitney U test was ; transient ischemic attack, MRS; modified Rankin scale, MRI; magnetic resonance image, NIHSS; National Institutes of Health Stroke Scale, WBC; white blood cell, Hb; hemoglobin, Hct; hematocrit, FBS; fasting blood sugar, HbA1c; glycosylated hemoglobin, BUN; blood urea nitrogen, Cr; creatinine, aPTT; activated partial thromboplastin time, PT; prothrombin time, AST; aspartate aminotransferase, ALT; ala-nine Ltd., Cork, Ireland) . 2841 417 . 24 222 (Fig.). 222 23 ( ) 1 . , . Table 1.