Leukoaraiosis and stroke outcome

Podgórska, Anna; Hier, Daniel B.; Pytlewski, A.; Członkowska, Anna

doi:10.1053/jscd.2002.130123

Cited by 21 publications

(18 citation statements)

References 41 publications

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“…Some studies found no association [6,7,] whereas a number of newer studies have found an association between white matter hyperintensities and an increased risk of recurrent stroke [8,9,10,11], as well as a poorer prognosis after ischemic stroke [12,13,14]. Thus, the severity of white matter hyperintensities may hold important information to aid risk stratification for recurrent ischemic stroke.…”

Section: Introductionmentioning

confidence: 99%

White Matter Hyperintensities Improve Ischemic Stroke Recurrence Prediction

Andersen¹,

Larsen

Gorst‐Rasmussen³

et al. 2016

Cerebrovasc Dis

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Background: Nearly one in 5 patients with ischemic stroke will invariably experience a second stroke within 5 years. Stroke risk stratification schemes based solely on clinical variables perform only modestly in non-atrial fibrillation (AF) patients and improvement of these schemes will enhance their clinical utility. Cerebral white matter hyperintensities are associated with an increased risk of incident ischemic stroke in the general population, whereas their association with the risk of ischemic stroke recurrence is more ambiguous. In a non-AF stroke cohort, we investigated the association between cerebral white matter hyperintensities and the risk of recurrent ischemic stroke, and we evaluated the predictive performance of the CHA₂DS₂VASc score and the Essen Stroke Risk Score (clinical scores) when augmented with information on white matter hyperintensities. Methods: In a registry-based, observational cohort study, we included 832 patients (mean age 59.6 (SD 13.9); 42.0% females) with incident ischemic stroke and no AF. We assessed the severity of white matter hyperintensities using MRI. Hazard ratios stratified by the white matter hyperintensities score and adjusted for the components of the CHA₂DS₂VASc score were calculated based on the Cox proportional hazards analysis. Recalibrated clinical scores were calculated by adding one point to the score for the presence of moderate to severe white matter hyperintensities. The discriminatory performance of the scores was assessed with the C-statistic. Results: White matter hyperintensities were significantly associated with the risk of recurrent ischemic stroke after adjusting for clinical risk factors. The hazard ratios ranged from 1.65 (95% CI 0.70-3.86) for mild changes to 5.28 (95% CI 1.98-14.07) for the most severe changes. C-statistics for the prediction of recurrent ischemic stroke were 0.59 (95% CI 0.51-0.65) for the CHA₂DS₂VASc score and 0.60 (95% CI 0.53-0.68) for the Essen Stroke Risk Score. The recalibrated clinical scores showed improved C-statistics: the recalibrated CHA₂DS₂VASc score 0.62 (95% CI 0.54-0.70; p = 0.024) and the recalibrated Essen Stroke Risk Score 0.63 (95% CI 0.56-0.71; p = 0.031). C-statistics of the white matter hyperintensities score were 0.62 (95% CI 0.52-0.68) to 0.65 (95% CI 0.58-0.73). Conclusions: An increasing burden of white matter hyperintensities was independently associated with recurrent ischemic stroke in a cohort of non-AF ischemic stroke patients. Recalibration of the CHA₂DS₂VASc score and the Essen Stroke Risk Score with one point for the presence of moderate to severe white matter hyperintensities led to improved discriminatory performance in ischemic stroke recurrence prediction. Risk scores based on white matter hyperintensities alone were at least as accurate as the established clinical risk scores in the prediction of ischemic stroke recurrence.

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Section: Introductionmentioning

confidence: 99%

White Matter Hyperintensities Improve Ischemic Stroke Recurrence Prediction

Andersen¹,

Larsen

Gorst‐Rasmussen³

et al. 2016

Cerebrovasc Dis

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“…Based on brain computed tomography (CT) imaging studies, WMHs have been found in 7–38% of the stroke subjects [5,6]. However, magnetic resonance imaging (MRI) provides a more sensitive image and has a higher prevalence of detecting WMHs than CT.…”

Section: Introductionmentioning

confidence: 99%

Cerebral White Matter Hyperintensities Predict Functional Stroke Outcome

et al. 2009

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Background: Growing evidence suggests that white matter hyperintensities (WMHs) are implicated in stroke recurrence and mortality, and their location can be a critical factor. This study evaluated the impact of periventricular WMHs (PVWMHs) and subcortical WMHs (SWMHs) on poststroke functional outcomes. Methods: Brain MRI was performed on 187 acute ischemic stroke patients (57.8% male; mean age = 64.3 years) recruited from the Kaohsiung Municipal Hsiao-Kang Hospital from February 2007 to January 2008. A Fazekas score ≥2 in the periventrcular or subcortical white matter was taken as presence of WMHs. Demographic data and risk factors for stroke were assessed. Functional stroke outcomes were evaluated 30 days after stroke using the Barthel Index (BI) and the modifiedRankin Scale (mRS). Results: WMHs were inversely linked to favorable functional outcome measured by mRS (p = 0.001) and BI (p = 0.003). Evaluating different locations, PVWMHs were associated with unfavorable functional outcomes (p = 0.002, mRS; p = 0.001, BI). SWMHs were related to mRS (p = 0.026) but not BI (p = 0.069). After controlling other stroke risk factors, infarct volumes and initial stroke severity, PVWMHs were a significant indicator for both mRS (OR = 2.76; 95% CI = 1.03–7.40) and BI (OR = 3.07; 95% CI = 1.13–8.40), but SWMHs were not. Conclusions: Unfavorable functional stroke outcome is associated with MRI WMHs. In terms of location, PVWMHs but not SWMHs are related to functional stroke outcome.

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“…3 A common finding in the elderly, 4,5 WMD has been shown to associate with recurrent stroke, 6,7 cognitive decline, [8][9][10] gait disturbances, 11,12 hemorrhagic transformation, 13 and functional outcome after ischemic stroke. [14][15][16][17] Most studies have examined the relationship between functional stroke outcome and WMD severity using either computed tomography visual scales 14,18,19 or volumetric measurements. 15,20 Although proposed to be more accurate than visual scales, 21 volumetric measurement of WMD lesions is time-intensive and not always available in the clinical setting.…”

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confidence: 99%