Association between cerebral small vessel disease burden and early neurological deterioration in isolated pontine infarction

Abstract Objective To investigate the association between cerebral small vessel disease burden and early neurological deterioration (END) in stroke patients with isolated pontine infarction. Methods A total of 107 acute isolated pontine infarct patients within 24 hours of symptoms onset were included from a comprehensive stroke center, the mean age is 67 years old. Cerebral small vessel disease burden on brain MRI including white matter hyperintensities (WMH), lacunes, cerebral microbleeds (CMB), and enlarged perivascular spaces (EPVS) were evaluated in each patient. END was defined as an increase of ≥ 1 point on the motor National Institutes of Health Stroke Scale (NIHSS) or ≥ 2 points on the total NIHSS score within 72 hours from admission. T-test, chi-square test, and logistic regression were used for statistical analysis. Results 33.6% (36/107) of them occurred END. Patients in the END group have a higher percentage of hyperlipidemia (66.7% vs. 43.7%, p = 0.024). over 50% of infarction mechanism can be attributed to basilar artery branch disease in both groups (58.3% in the END group and 50.7% in the non-END group). In multivariate regression, neither cerebral small vessel disease total burden nor WMH, CMB, lacunes, and EPVS were associated with END (all P >0.05). Basilar artery intraplaque hemorrhage on vessel wall imaging is associated with END independently (OR = 3.233, 95% CI 1.032–10.123, p = 0.044). Conclusion Neither cerebral small vessel disease burden nor its individual imaging features were associated with END in isolated pontine infarction patients. Basilar artery intraplaque hemorrhage is an independent predictor of END in this population.