The infarct location predicts progressive motor deficits in patients with acute lacunar infarction in the lenticulostriate artery territory

Background and purpose: Patients with acute lacunar infarction in the lenticulostriate artery (LSA) territory often show progression of motor deficits (PMD) after admission. The purpose of our study is to identify predictors for PMD using the findings of diffusion-weighted imaging (DWI) on admission. Methods: From January 2005 to December 2008, we studied 60 consecutive patients with acute lacunar infarction in the LSA territory within 24 h after onset. To identify predictors for PMD, clinical characteristics including vascular risk factors and DWI findings were evaluated. DWI findings included the size and location of the infarcts and the slice numbers of infarcts visible on DWI. For the location, posterior type was defined as an infarct located in the posterior part of corona radiata on the second slice from the top among slices including corona radiata. Results: Twenty-six patients (43%) showed PMD. In univariate analysis, age >= 75 (P=0.03), female sex (P=0.04), infarct slice number >= 3 (P=0.04), and posterior type infarct (P<0.001) were more frequent in the PMD group than in the no PMD group. In multivariate analysis, posterior type infarct was the only independent predictor among DWI findings for PMD (odds ratio, 14.83; 95% confidence interval, 3.54-87.21, P<0.001). Conclusions: Posterior type infarct was the independent predictor in DWI findings for PMD in patients with lacunar infarction in the LSA territory. We postulate that the posterior type infarct may affect the corticospinal tract to a greater degree and cause PMD. (C) 2010 Elsevier B.V. All rights reserved.