Objective: The aim of this investigation was to examine the association between the serum
homocysteine (Hcy) level and the distal single small subcortical infarction (dSSSI).
Methods: Consecutive patients were prospectively recruited in a registered hospital-based ischemic
stroke database. Baseline characteristics and risk factors of single small subcortical infarction
(SSSI), including the serum Hcy level, were assessed. The SSSI located in the lenticulostriate artery
(LSA) territory was divided into proximal single small subcortical infarction (pSSSI) and dSSSI
based on a standard template on axial diffusion-weighted imaging (DWI). The association between
the serum Hcy level and dSSSI was analysed by multivariate logistic regression analysis.
Results: Out of 3,247 patients, a total of 572 patients were included in the final analysis. We found
that dSSSI had a higher serum Hcy level than pSSSI. Elevated Hcy level was independently correlated
with dSSSI. Compared with the lowest quartile, the upper quartiles of Hcy level were independently
associated with dSSSI, the odds ratio for the second quartile was 1.748 (95%CI 1.019 to
3.000), 1.824 (95% CI 1.060 to 3.140) for the third quartile, and 2.010 (95% CI 1.155 to 3.497) for
the fourth quartile. The restricted cubic spline showed that the higher level of Hcy, the greater risk of
Conclusion: The dSSSI shows higher serum Hcy level than pSSSI. Elevated serum Hcy is more
closely related to dSSSI. In the future, the effectiveness of Hcy-lowering therapy for dSSSI needs to
be explored by further clinical studies.