Title:Prevalence and Prognostic Factors of Cortical Laminar Necrosis in Acute
Ischemic Stroke
Volume: 20
Issue: 2
Author(s): Zhi-li Wang, Wei Qin, Yuelei Lyu and Wenli Hu*
Affiliation:
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
Keywords:
Cortical laminar necrosis, stroke, risk factors, magnetic resonance imaging, large artery atherosclerosis, prognosis.
Abstract:
Background: Cortical laminar necrosis (CLN) is a specific type of cortical infarction,
and little is known about its frequency and outcomes. We aimed to investigate the prevalence and
outcomes of CLN caused by brain infarction and its prognostic factors.
Methods: This retrospective cohort study included patients with acute ischemic stroke (AIS) between
2019 and 2022 and for whom magnetic resonance images obtained at our center showed
acute-stage CLN. Their medical records were collected and analyzed. An unfavorable outcome
was defined as a modified Rankin Scale score of 3-6 at 90 days. Logistic regression was performed
to identify independent predictors of an unfavorable outcome.
Results: Among 5548 consecutive patients with AIS, 151 patients (2.7%) were diagnosed with
CLN, and 112 had CLN enrolled in the final analysis. At 90 days, 25 patients (22.3%) had an unfavorable
outcome. Compared with the favorable group, poor outcome patients had higher rates of
previous stroke (p = 0.012), higher National Institutes of Health Stroke Scale (NIHSS) scores at
admission (p < 0.001), and were more likely to have early neurologic deterioration (END) (p =
0.014), diffuse ischemic lesions (p = 0.011), and lesions involving multiple lobes (p = 0.030). In
multivariable analysis, the initial NIHSS score (OR, 1.258, (95% CI 1.090 - 1.453), p = 0.002) and
END (OR, 5.695, [95% CI 1.410 - 23.007], p = 0.015) were independently associated with unfavorable
outcome.
Conclusion: CLN is a rare ischemic event but has a good prognosis in most cases. A higher initial
NIHSS score and END may predict an unfavorable outcome.
