Risk factors, clinical presentation and 1-year outcome of ischemic stroke caused by small artery disease

Abstract

Background The prevalence of ischemic stroke (IS) caused by small-artery disease (SAD) is increasing recently. The present study aimed to report the risk factors, clinical presentations and outcome in patients presented with IS due to SAD with follow up for one year. The present study included 100 patients with IS due to SAD diagnosed on the basis of clinical and radiological findings. All patients were submitted to careful history taking, thorough clinical examination and standard laboratory work-up. Assessment of neurological functions was achieved using the National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). Cognitive functions were evaluated using Trail making test, Stroop color word test, Arithmetic test, Vocabulary test, Wechsler adult intelligence scale IV digit span forward assessment and backward assessment. Magnetic resonance imaging (MRI) was done using a standard 1.5 Tesla unit. According to radiological findings, patients were classified into three groups: GI (n = 40) with IS due to SAD, GII (n = 30) with IS due to SAD plus internal watershed infarcts and GIII (n = 30) with IS due to SAD plus large artery infarctions (n = 30). Results Comparison between the three groups regarding the reported risk factors identified significantly lower frequency of hyperlipidemia in GI patients as compared to GII and GIII patients (35.0% versus 60.0% and 66.7% respectively, p = 0.018). Clinically, it was shown that GI patients had significantly higher frequency of dizziness, dysphasia and tinnitus in comparison to the other two groups. It was also shown that those patients had significantly lower mean cortical thickness at the end of follow up (3.12 ± 0.9 versus 2.22 ± 0.8, p = 0.031). Finally, MRI brain volumetric study showed significantly decreased total cerebral cortical volume (TCCV) (589,456 ± 1689 versus 559,152 ± 1459) and total cerebral white matter volume (TCWMV) (521,546 ± 1785 versus 501,306 ± 1259) at the end of follow up. Conclusions Ischemic stroke caused by small artery disease is related to poor outcome with deterioration of cognitive functions.