Cerebral small vessel disease and its impact on the course and outcome of stroke

Abstract

<jats:p>Cerebral small vessel disease (CSVD) is a common cause of stroke (25 % of all strokes) and has a significant contribution to development dementia, functional loss and increases the risk of death. Validation of methods for assessing the total cerebral small vessel disease burden on CT and MRI makes it possible to more accurately and fully assess the impact of the cumulative effect of cerebrovascular pathology on the development and consequences of stroke after 3 months. The aim of our study was to investigate the prognostic value of the total CSVD burden and its individual features (leukoaraiosis, lacunes, brain atrophy) on the course and outcome of stroke at 90 days. 131 patients with ischemic stroke, diagnosed according to TOAST criteria, were enrolled. All patients underwent computed tomography on a General Electric CT/e device (Italy) with a slice thickness of 3–7 mm. Leukoaraiosis was diagnosed and scored by the visual scale of Fazekas and von Swieten. Brain atrophy was assessed separately in central and cortical regions by validated standard template. Lacunes were defined according to the standard protocol. We calculated the total CSVD burden (composed leukoaraiosis, lacunes, brain atrophy) with and without brain atrophy. We assessed the severity of neurological deficit by the NIHSS scale. The functional outcome and the degree of disability or dependence in the daily activities we measured by modified Rankin scale and Barthel index. MMSE was used to assess cognitive function. Statistical analyses were performed by SPSS 25.0 software (IBM Corp., Armonk, NY, USA). We used Student’s t-test or Mann-Whitney U test, Pearson or Spearman correlation and regression analysis. Our data have shown that cerebral small vessel disease is negatively correlated with the consequences of stroke and reflect brain frailty and impair regenerative potential. The degree of cognitive deficit was associated with negative prognostic consequences of stroke. The total cerebral small vessel disease burden is a valuable prognostic marker of stroke prognosis and can be used as a tool for the assessment of effectiveness of preventive and curative measures.</jats:p>