Initial MRI findings predict progressive lacunar infarction in the territory of the lenticulostriate artery

Background/Aims: The mechanisms underlying neurological deterioration in patients with acute lacunar infarction in the lenticulostriate artery (LSA) territory are currently unclear. We aimed to identify predictors for progressive neurological deficits using diffusion-weighted imaging (DWI). Methods: We studied 40 consecutive patients who were classified into two groups based on their NIHSS scores: progressive infarction (PI) and non-progressive infarction (NPI). We calculated the size of DWI abnormalities and evaluated clinical characteristics on admission for both groups. Results: 19 patients (47.5%) exhibited neurological deterioration. Time from onset to MRI was 8.2 ± 6.7 h for all patients. DWI area was significantly larger in the PI relative to the NPI group (1.1 ± 0.5 cm² for PI vs. 0.7 ± 0.3 cm² for NPI; p = 0.002), although patients' NIHSS scores at admission were not significantly different between both groups. The optimal cut-off value of infarct area between PI and NPI was 0.98 cm². Multivariate analysis revealed that an infarct area on DWI ≥0.98 cm² (odds ratio 10.57; 95% confidence interval 2.24-68.32; p = 0.006) was a significant independent predictor of PI. Conclusions: A large infarct area on initial DWI was an independent predictor of neurological deterioration in patients with acute lacunar infarctions in the LSA territory.