The progressive course of neurological symptoms in anterior choroidal artery infarcts

Background Infarctions of the anterior choroidal artery affect multiple anatomical structures, leading to a wide spectrum of neurological deficits with frequent symptom fluctuation or progression. Aims To assess etiological mechanisms, frequency, and predictors of symptom progression, as well as its impact on prognosis. Methods Anterior choroidal artery infarct patients were prospectively identified via predefined infarct locations with ischemic lesions >= 1.5 cm vertical diameter in cerebral imaging. Definition of neurological progression was >= 2 National Institutes of Health Stroke Scale points in motor function or >= 4 in total National Institutes of Health Stroke Scale. Stroke etiology was determined according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. We assessed demographical data, risk factors, and acute phase parameters in order to find predictors of neurological progression. Results Thirty patients fulfilled the inclusion criteria. Eighteen patients (60%) had neurological progression during days 1-3. Despite similar stroke severity at admission (median National Institutes of Health Stroke Scale in progressive infarcts 4.5 versus 4; P = 0.72), patients with progression had more severe deficits at day 3 (median National Institutes of Health Stroke Scale 9 vs. 3.5; P = 0.04) and worse three-month outcome. Only 31% of patients with progression scored <2 in the modified Rankin Scale compared with 89% without progression (P = 0.01) after three-months. No statistically significant differences regarding possible predictors of progression were found. Magnetic resonance imaging findings and etiological assessment suggest overlapping mechanisms of small and large vessel disease. Conclusions Neurological deterioration is frequent in anterior choroidal artery infarcts and is associated with worse outcome. While mechanisms of small and large vessel disease seem to overlap in anterior choroidal artery infarction, we were not able to identify predictors of neurological progression.