LAUSR

In Response: We recently published an article entitled “Predictors of Early Neurological Deterioration in Acute Pontine Infarction,” which revealed that the maximum length multiplied by thickness may be a possible predictor in the evaluation of progression with isolated acute pontine infarction, thus suggesting the extent of pontine infarction along the conduction tract may contribute to early neurological deterioration (END). As Cao et al commented on our article and raised some considerations, we made relevant responses at the invitation of the editor. The National Institutes of Health Stroke Scale score is the most widely used tool to evaluate the degree of neurological deficit. The scale is simple and reliable, but its sensitivity is low. Some imaging assessment and other evaluation methods combined with practice may provide more accurate and sensitive prediction methods. Because little can be done to alter the course of stroke before hospital admission, most studies have focused on neurological worsening occurring after hospital admission. Few studies, however, have based their definition of neurological worsening on a very short delay from the start of ischemic symptoms to hospital admission. Due to the limited number (brief report), we did not elaborate the inclusion criteria and exclusion criteria in the article, but our criteria were consistent with those of Semi et al. In addition, all enrolled patients were not treated with intravenous thrombolysis or interventional thrombectomy. Atrial fibrillation patients were very few; >95% of them were treated with antiplatelet therapy, and other conventional therapies were basically the same.We have enrolled patients with isolated pontine infarction for 10 years. The time span of hospital admission is uncontrollable, so it is impossible for all patients to complete magnetic resonance imaging within 24 hours after onset or after admission. Many studies also select patients who complete magnetic resonance imaging within 48 hours after onset or after admission. The levels of maximum ventrodorsal length and rostrocaudal thickness were higher in END group than those in non-END group in univariate analysis (both P<0.001), which were not included in the multivariate regression analysis, but replaced by the maximum length multiplied by thickness in our study. This is a method of variable replacement in biomedical statistics, and we suggest Cao et al to further study SPSS software. There were no significant differences in the incidence of only lesion section involvement of the lower pons with END group than without END group in our study. It was not consistent with the results of Semi et al. We hope to find a more simple and easy-to-operate method to evaluate the END of pons infarction. Combined with the particularity of pons infarction (the divergent distribution of corticospinal tracts in pons), we draw the current research conclusions. Although the conclusion needs further confirmation, it provides a new evaluation method for clinicians. Finally, the association between basilar stenosis and END remains controversial. The occurrence of END was related to the severity of basilar stenosis. This is consistent with the results of Nakase et al. Our current research does not involve the association between basilar plaque by high-resolution magnetic resonance imaging and END. If Cao et al are interested in basilar plaque, they could further study it.