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Effects of White Matter Hyperintensities on 90-Day Functional Outcome after Large Vessel and Non-Large Vessel Stroke
- Source :
- Cerebrovasc Dis
- Publication Year :
- 2020
- Publisher :
- S. Karger AG, 2020.
-
Abstract
- Introduction: White matter hyperintensity (WMH) burden is a critically important cerebrovascular phenotype related to the diagnosis and prognosis of acute ischemic stroke. The effect of WMH burden on functional outcome in large vessel occlusion (LVO) stroke has only been sparsely assessed, and direct LVO and non-LVO comparisons are currently lacking. Material and Methods: We reviewed acute ischemic stroke patients admitted between 2009 and 2017 at a large healthcare system in the USA. Patients with LVO were identified and clinical characteristics, including 90-day functional outcomes, were assessed. Clinical brain MRIs obtained at the time of the stroke underwent quantification of WMH using a fully automated algorithm. The pipeline incorporated automated brain extraction, intensity normalization, and WMH segmentation. Results: A total of 1,601 acute ischemic strokes with documented 90-day mRS were identified, including 353 (22%) with LVO. Among those strokes, WMH volume was available in 1,285 (80.3%) who had a brain MRI suitable for WMH quantification. Increasing WMH volume from 0 to 4 mL, age, female gender, a number of stroke risk factors, presence of LVO, and higher NIHSS at presentation all decreased the odds for a favorable outcome. Increasing WMH above 4 mL, however, was not associated with decreasing odds of favorable outcome. While WMH volume was associated with functional outcome in non-LVO stroke (p = 0.0009), this association between WMH and functional status was not statistically significant in the complete case multivariable model of LVO stroke (p = 0.0637). Conclusion: The burden of WMH has effects on 90-day functional outcome after LVO and non-LVO strokes. Particularly, increases from no measurable WMH to 4 mL of WMH correlate strongly with the outcome. Whether this relationship of increasing WMH to worse outcome is more pronounced in non-LVO than LVO strokes deserves additional investigation.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
Large vessel
030204 cardiovascular system & hematology
Severity of Illness Index
behavioral disciplines and activities
Article
Brain Ischemia
White matter
Disability Evaluation
03 medical and health sciences
0302 clinical medicine
Leukoencephalopathies
Predictive Value of Tests
Risk Factors
Internal medicine
mental disorders
Humans
Medicine
Registries
Favorable outcome
Stroke
Aged
Retrospective Studies
Aged, 80 and over
business.industry
Ischemic strokes
Stroke Rehabilitation
Recovery of Function
Middle Aged
medicine.disease
Magnetic Resonance Imaging
Hyperintensity
Treatment Outcome
medicine.anatomical_structure
Neurology
Cardiology
Female
Functional status
Neurology (clinical)
Cardiology and Cardiovascular Medicine
business
030217 neurology & neurosurgery
Large vessel occlusion
Subjects
Details
- ISSN :
- 14219786 and 10159770
- Volume :
- 49
- Database :
- OpenAIRE
- Journal :
- Cerebrovascular Diseases
- Accession number :
- edsair.doi.dedup.....0b868b9748dd792c7cee98c3b781bf66