Background and objectives: The present study evaluated relationships of clinical aggravation with the location and volume enlargement of acute small ischemic stroke developed in basal ganglia and pons. Methods: We analyzed clinical and radiological data of 44 patients, who were diagnosed as lacunes or BAD occurred in basal ganglia (n=26) or pons (n=18) on initial diffusion weighted image (DWI) and took follow-up DWI within 1 week. Neurological changes between the time points of initial and follow-up DWI were checked using National Institute of Health Stroke Scale (NIHSS). Symptom changes were classified into no-aggravation (0 or 1 of NIHSS change) and aggravation group (≥2). Lesion volume located in basal ganglia or pons was measured on initial and follow-up DWI images using a program (ITK-SNAP). The lesion location and volume differences of acute lesion was compared between no-aggravation and aggravation groups. Results: Symptom aggravation was observed in 17 (38.6 %, basal ganglia, 10 vs. pons, 7) of total patients. Lesion volume was enlarged from initial 1759 mm3 to follow-up 3699mm3 in basal ganglia infarction (p<0.001), and, from 669 mm3 to 1220 mm3 in pontine infarction (p<0.001). The lesion volume was significantly higher in aggravation group of both basal ganglia (aggravation, 2854±2020 mm3; no-aggravation group, 1369±1305 mm3, Mann-Whitney, p=0.036) and pontine infarction (aggravation, 751±222 mm3; no-aggravation group, 424±368 mm3, p=0.044). Conclusion: The present study showed the severity of volume enlargement related with symptom aggravation in acute basal ganglia and pontine small infarctions.
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