Extent of White Matter Lesions is Related to Acute Subcortical Infarcts and Predicts Further Stroke Risk in Patients with First Ever Ischaemic Stroke

Overview

Journal J Neurol Neurosurg Psychiatry

Publisher BMJ Publishing Group

Specialties Neurology
Neurosurgery
Psychiatry

Date 2005 May 18

PMID 15897500

Citations 44

Authors

J H Fu

C Z Lu

Z Hong

Q Dong

Y Luo

K S Wong

Affiliations

Soon will be listed here.

Abstract

Objective: To investigate whether the extent of white matter lesions (WML) on fluid attenuated inversion recovery (FLAIR) MRI sequences is an independent risk factor for recurrent stroke, and to document the pattern of acute cerebral infarcts using diffusion weighted imaging (DWI) in patients with different severities of WML.

Methods: In a prospective cohort study, 228 consecutive stroke patients were studied between 1999 and 2001 in a community hospital. The severity of WML was graded as 0 (no WML), 1 (mild), 2 (moderate), or 3 (severe) according to the FLAIR appearances. DWI was used to document the location and size of the infarct.

Results: 31 patients had grade 0 WML, 69 had grade 1, 59 had grade 2, and 69 had grade 3. Age was independently associated with WML on logistic regression analysis (p = 0.0001). Acute cerebral infarcts in deep white matter were correlated with increasing severity of WML. On a median follow up of 23.0 months, life table analysis showed that recurrent stroke was related to the severity of WML (recurrence rate 7.8% in grade 0, 9.3% in grade 1, 17.7% in grade 2, 43.7% in grade 3; p = 0.0001). Survival was reduced in patients with severe WML (p = 0.0068). A Cox proportional hazards model showed WML to be predictive of recurrent stroke (p = 0.000, hazard ratio = 4.177 (95% confidence interval, 2.038 to 8.564)) and also for survival (p = 0.040, hazard ratio = 2.021 (1.032 to 3.960)).

Conclusions: Patients with severe leukoaraiosis have increased risk of deep subcortical stroke and a higher risk of recurrent stroke.

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References

Wiszniewska M, Devuyst G, Bogousslavsky J, Ghika J, van Melle G . What is the significance of leukoaraiosis in patients with acute ischemic stroke?. Arch Neurol. 2000; 57(7):967-73. DOI: 10.1001/archneur.57.7.967. View

de Groot J, de Leeuw F, Oudkerk M, van Gijn J, Hofman A, Jolles J . Cerebral white matter lesions and cognitive function: the Rotterdam Scan Study. Ann Neurol. 2000; 47(2):145-51. DOI: 10.1002/1531-8249(200002)47:2<145::aid-ana3>3.3.co;2-g. View

Herskovits E, Itoh R, Melhem E . Accuracy for detection of simulated lesions: comparison of fluid-attenuated inversion-recovery, proton density--weighted, and T2-weighted synthetic brain MR imaging. AJR Am J Roentgenol. 2001; 176(5):1313-8. DOI: 10.2214/ajr.176.5.1761313. View

Wahlund L, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjogren M . A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke. 2001; 32(6):1318-22. DOI: 10.1161/01.str.32.6.1318. View

Ohta K, Obara K, Yogo Y, Takane H, Shigihara T . [Chronological changes of lacunar infarctions on fluid-attenuated inversion recovery magnetic resonance images]. Rinsho Shinkeigaku. 2002; 41(6):277-82. View

Helenius J, Soinne L, Salonen O, Kaste M, Tatlisumak T . Leukoaraiosis, ischemic stroke, and normal white matter on diffusion-weighted MRI. Stroke. 2002; 33(1):45-50. DOI: 10.1161/hs0102.101228. View

Yamauchi H, Fukuda H, Oyanagi C . Significance of white matter high intensity lesions as a predictor of stroke from arteriolosclerosis. J Neurol Neurosurg Psychiatry. 2002; 72(5):576-82. PMC: 1737875. DOI: 10.1136/jnnp.72.5.576. View

Streifler J, Eliasziw M, Benavente O, Alamowitch S, Fox A, Hachinski V . Prognostic importance of leukoaraiosis in patients with symptomatic internal carotid artery stenosis. Stroke. 2002; 33(6):1651-5. DOI: 10.1161/01.str.0000018010.38749.08. View

Wong T, Klein R, Sharrett A, Couper D, Klein B, Hubbard L . Cerebral white matter lesions, retinopathy, and incident clinical stroke. JAMA. 2002; 288(1):67-74. DOI: 10.1001/jama.288.1.67. View

10.

de Groot J, de Leeuw F, Oudkerk M, van Gijn J, Hofman A, Jolles J . Periventricular cerebral white matter lesions predict rate of cognitive decline. Ann Neurol. 2002; 52(3):335-41. DOI: 10.1002/ana.10294. View

11.

Vermeer S, Hollander M, van Dijk E, Hofman A, Koudstaal P, Breteler M . Silent brain infarcts and white matter lesions increase stroke risk in the general population: the Rotterdam Scan Study. Stroke. 2003; 34(5):1126-9. DOI: 10.1161/01.STR.0000068408.82115.D2. View

12.

Geroldi C, Galluzzi S, Testa C, Zanetti O, Frisoni G . Validation study of a CT-based weighted rating scale for subcortical ischemic vascular disease in patients with mild cognitive deterioration. Eur Neurol. 2003; 49(4):193-209. DOI: 10.1159/000070183. View

13.

van Swieten J, van den Hout J, van Ketel B, Hijdra A, Wokke J, van Gijn J . Periventricular lesions in the white matter on magnetic resonance imaging in the elderly. A morphometric correlation with arteriolosclerosis and dilated perivascular spaces. Brain. 1991; 114 ( Pt 2):761-74. DOI: 10.1093/brain/114.2.761. View

14.

van Swieten J, Kappelle L, Algra A, van Latum J, Koudstaal P, van Gijn J . Hypodensity of the cerebral white matter in patients with transient ischemic attack or minor stroke: influence on the rate of subsequent stroke. Dutch TIA Trial Study Group. Ann Neurol. 1992; 32(2):177-83. DOI: 10.1002/ana.410320209. View

15.

MIYAO S, Takano A, Teramoto J, Takahashi A . Leukoaraiosis in relation to prognosis for patients with lacunar infarction. Stroke. 1992; 23(10):1434-8. DOI: 10.1161/01.str.23.10.1434. View

16.

Munoz D, Hastak S, Harper B, Lee D, Hachinski V . Pathologic correlates of increased signals of the centrum ovale on magnetic resonance imaging. Arch Neurol. 1993; 50(5):492-7. DOI: 10.1001/archneur.1993.00540050044013. View

17.

Burn J, Dennis M, Bamford J, Sandercock P, Wade D, Warlow C . Long-term risk of recurrent stroke after a first-ever stroke. The Oxfordshire Community Stroke Project. Stroke. 1994; 25(2):333-7. DOI: 10.1161/01.str.25.2.333. View

18.

Jorgensen H, Nakayama H, Raaschou H, Olsen T . Leukoaraiosis in stroke patients. The Copenhagen Stroke Study. Stroke. 1995; 26(4):588-92. DOI: 10.1161/01.str.26.4.588. View

19.

Fisher M, Prichard J, Warach S . New magnetic resonance techniques for acute ischemic stroke. JAMA. 1995; 274(11):908-11. View

20.

van Zagten M, Boiten J, Kessels F, Lodder J . Significant progression of white matter lesions and small deep (lacunar) infarcts in patients with stroke. Arch Neurol. 1996; 53(7):650-5. DOI: 10.1001/archneur.1996.00550070088015. View