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Brain and behavior
Por Qiang H, Ying C y Yongbo Z.
Contenido en inglés
To investigate the natural course of cerebral small vessel disease (CSVD) manifested as pure thalamic infarction (PTI) and identify predictors of 90-day clinical prognosis and 1-year recurrent major adverse cardiovascular/cerebrovascular events (MACE).
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This retrospective cohort study analyzed 251 consecutive thalamic infarction patients admitted between January 2016 and May 2024. Participants were classified into PTI (n = 187) or combined-type thalamic infarction (CTI, n = 64). Primary endpoints included poor 90-day clinical prognosis (modified Rankin Scale [mRS] ≥ 2) and 1-year MACE (composite of stroke, acute myocardial infarction, and cardiovascular death). Intergroup comparisons utilized Pearson Chi-square or Mann-Whitney U tests, with variables showing p ≤ 0.10 in univariate analysis entered into multivariate logistic regression models.
Compared with CTI, PTI patients demonstrated lower baseline National Institutes of Health Stroke Scale (NIHSS) scores (median 1 vs. 3, p < 0.001) and reduced prevalence of atrial fibrillation (2.7% vs. 12.5%), intracranial artery stenosis (ICAS; 48.1% vs. 76.6%), and early neurological deterioration (24.6% vs. 56.3%; all p < 0.05). The 90-day poor prognosis rate was significantly lower in PTI (4.8% vs. 20.3%, p < 0.001), whereas 1-year MACE rates did not differ between groups (12.3% vs. 15.6%, p = 0.497). Among PTI cases, territorial distributions comprised inferolateral (80.2%), tuberothalamic (13.4%), paramedian (including Percheron artery, 5.9%), and posterior choroidal arteries (0.5%). Tuberothalamic artery infarctions exhibited higher cognitive impairment rates (36.0%) than other subgroups. Multivariate analysis identified baseline NIHSS as an independent predictor of 90-day poor prognosis (OR = 1.634, 95% CI 1.152-2.320, p = 0.006), while ICAS was associated with 1-year MACE (OR = 3.908; 95% CI, 1.188-12.849; p = 0.025) in PTI patients.
PTI presented favorable short-term outcomes, consistent with initial stroke severity, yet carried a 12.3% annual MACE risk, particularly in patients with coexisting ICAS. These findings underscore the importance of addressing intracranial stenosis in secondary prevention strategies for CSVD.
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