Key result
Five-variable risk score reliably predicts early neurological deterioration in isolated pontine stroke.
Cohort (n=91)
No
In isolated pontine stroke, early neurological deterioration is strongly predicted by anteromedial lesion location, surface extension, and larger infarct volume, which can be incorporated into a predictive risk score.
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Supports lesion-based END risk stratification in pontine stroke; leaves open prospective validation before clinical adoption.
BACKGROUND AND AIMS: Pontine ischemic strokes are feared for their propensity to undergo early neurological deterioration (END). This study aimed to assess clinical and imaging predictors of END in patients with isolated pontine stroke and develop a candidate END risk score. METHODS: We retrospectively analyzed 91 patients admitted to our stroke center (2009-2024) with confirmed isolated pontine infarction. Patients with ≥ 50% basilar stenosis were excluded; END was defined as a ≥ 2-point NIHSS worsening within 48 h. RESULTS: END occurred in 28.5% (26/91) of cases and was associated with higher premorbid disability (mRS ≥ 2: 38.5% vs. 15.4%, p = 0.025) and greater small vessel disease burden (Fazekas ≥ 2: 69.2% vs. 47.7%, p = 0.030) compared with the non-END group. Pontine warning syndrome (PWS) was more frequent among END cases (19.2% vs. 6.2%, p = 0.11). All END cases involved anteromedial lesions (100% vs. 58.5%, p < 0.001), more frequently extending to the ventral pontine surface (84.6% vs. 33.8%, p < 0.001) and exhibiting larger infarct volume (0.45 vs. 0.26 mL, p < 0.001). END was associated with higher NIHSS at discharge (median 6 vs. 2, p < 0.001) and worse functional outcome at 90 days (median mRS 3 vs. 1, p < 0.001). A five-variable END risk score based on clinical and imaging predictors showed good discriminative performance (optimism-corrected AUC = 0.84; 95% CI 0.80-0.88). CONCLUSIONS: In isolated pontine stroke, END was associated to anteromedial lesion location, surface extension, premorbid disability, small vessel disease burden, and clinical PWS. If validated in future studies, the proposed END risk score may support early patient risk stratification.
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Dell’Acqua et al. (2026) conducted a cohort in Isolated pontine stroke (n=91). Five-variable END risk score was evaluated on Early neurological deterioration (END) defined as a ≥2-point NIHSS worsening within 48 h (AUC 0.84, 95% CI 0.80-0.88). A five-variable risk score demonstrated good discriminative performance for predicting early neurological deterioration in isolated pontine stroke.
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