Effect of White Matter Hyperintensity on the Functional Outcome of Ischemic Stroke Patients after Inpatient Stroke Rehabilitation

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.

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Antioxidative activity of statins and HDL-PON1 association in lacunar ischemic stroke with and without white matter hyperintensity

10.22514/sv.2021.003 ◽

2021 ◽

Keyword(s):

Antioxidant Activity ◽

Ischemic Stroke ◽

White Matter ◽

Medical Center ◽

Density Lipoprotein ◽

Statin Treatment ◽

Paraoxonase 1 ◽

White Matter Hyperintensity ◽

Pon1 Activity ◽

Stroke Patients

Purpose: Statins (HMG-coA reductase inhibitors) protect vessels from atherosclerosis through various mechanisms, but the clinical significance of statin-induced high-density lipoprotein cholesterol (HDL) changes has not been established. We evaluated the effects of statin treatment on the antioxidative activities of HDLs in ischemic stroke patients with and without white matter hyperintensity (WMH). Methods: From January to December in 2013, eighty-two ischemic stroke patients (57 men, 25 women; mean age 67.0 ± 11.8 years) at the Wonkwang Medical Center were recruited retrospectively and antioxidant activity was assessed via paraoxonase 1 (PON1) activity. We studied changes in the patients’ lipid profiles and assessed PON1 activity in patients with and without WMH, at baseline and 8 weeks after treatment with rosuvastatin 10 mg/d. Results: All patients evaluated antioxidant activity using PON1 activity at admission. After 8 weeks of rosuvastatin treatment, the mean HDL concentration increased to 0.83± 10.1 mg/dL. The HDL levels increased in 54 patients (64.3%) and decreased in 30 patients (35.7%). PON1 activity increased to 15.0% in all patients, regardLess of WMH after rosuvastatin treatment (+ 25.4% in subjects without WMH; P < 0.001). Baseline PON1 activity modestly correlated with HDL levels (r = 0.365, P = 0.019); however, PON1 activity after treatment did not correlate with HDL levels (r = 0.149, P = 0.347). Conclusion: Our findings suggest that statins increase antioxidant activity, especially assessed via PON1 activity, in ischemic stroke patients who did not have WMH.

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WHITE MATTER HYPERINTENSITY SEVERITY PREDICTS DEVELOPMENT OF CEREBRAL OEDEMA IN PATIENTS WITH ISCHEMIC STROKE TREATED WITH IV THROMBOLYSIS: IMPLICATIONS FOR INFARCT GROWTH AND FUNCTIONAL OUTCOME

10.26226/morressier.5ab8f55ad462b8029238c7c9 ◽

2018 ◽

Author(s):

Svetlana Lorenzano

Keyword(s):

Ischemic Stroke ◽

White Matter ◽

Functional Outcome ◽

Cerebral Oedema ◽

White Matter Hyperintensity

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Abstract P317: White Matter Hyperintensity Lesion Burden Modulates Functional Outcome After Acute Ischemic Stroke

Stroke ◽

10.1161/str.52.suppl_1.p317 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Anna K Bonkhoff ◽

Sungmin Hong ◽

Markus Schirmer ◽

Martin Bretzner ◽

Anne-Katrin Giese ◽

...

Keyword(s):

Ischemic Stroke ◽

White Matter ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

White Matter Hyperintensity ◽

Study Cohort ◽

Stroke Severity ◽

Ischemic Lesion ◽

Long Term Outcome ◽

Index Stroke

Introduction: As a radiographic signature of end-stage small vessel disease, white matter hyperintensity (WMH) burden impacts recovery and outcomes after acute ischemic stroke (AIS). In this study, we sought to investigate the effect of WMH volume (WMHv) on stroke severity and functional outcomes independent of the infarct size and topography. Methods: We analyzed 503 AIS patients with MRI data obtained on admission for index stroke enrolled in the multi-center MRI-GENIE study (cohort 1), followed by validation of the findings in an independent single-site study of 555 AIS patients (cohort 2). Stroke severity (NIHSS score) at index stroke and the long-term outcome (3-6 months mRS score) were modeled via Bayesian linear regression. Models included WMHv, age, sex, a 10-dimensional spatial ischemic lesion representation, acute infarct (DWI) volume, and common vascular risk factors (hypertension, diabetes mellitus, atrial fibrillation, coronary artery disease). Results: Cohorts did not differ significantly in major clinical characteristics [cohort 1: age: 65.0±14.6, 41% female, NIHSS: 5.5±5.4, mRS: 1(iqr 2); cohort 2: age: 65.0±14.8, 38% female, NIHSS: 5.0±6.0, mRS: 1(iqr 3), p >0.05 for all comparisons]. WMHv did not substantially affect AIS severity ( Fig A ); in contrast, it emerged as an independent predictor of functional outcome in both datasets ( Fig B ). Conclusions: When accounted for AIS lesion topography and stroke volume, total WMH lesion burden did not appear to modulate initial stroke severity but was associated with worse functional post-stroke outcomes. Future studies are needed to explore potential origins of these detrimental effects of pre-existing WMH burden on recovery after AIS.

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White Matter Lesion Severity in Mild Acute Ischemic Stroke Patients and Functional Outcome After 1 Year

Stroke ◽

10.1161/strokeaha.111.646554 ◽

2012 ◽

Vol 43 (11) ◽

pp. 3046-3051 ◽

Cited By ~ 30

Author(s):

Christopher O. Leonards ◽

Nils Ipsen ◽

Uwe Malzahn ◽

Jochen B. Fiebach ◽

Matthias Endres ◽

...

Keyword(s):

Ischemic Stroke ◽

White Matter ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

White Matter Lesion ◽

Stroke Patients ◽

Lesion Severity

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Prospectively Collected Cardiovascular Biomarkers and White Matter Hyperintensity Volume in Ischemic Stroke Patients

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2020.104704 ◽

2020 ◽

Vol 29 (5) ◽

pp. 104704

Author(s):

Pamela M. Rist ◽

Nancy R. Cook ◽

Julie E. Buring ◽

Kathryn M. Rexrode ◽

Natalia S. Rost

Keyword(s):

Ischemic Stroke ◽

White Matter ◽

White Matter Hyperintensity ◽

Stroke Patients ◽

Cardiovascular Biomarkers

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White Matter Hyperintensity, Immediate Antihypertensive Treatment, and Functional Outcome After Acute Ischemic Stroke

Stroke ◽

10.1161/strokeaha.119.028841 ◽

2020 ◽

Vol 51 (5) ◽

pp. 1608-1612

Author(s):

Shiguang Zhu ◽

Sifan Qian ◽

Tan Xu ◽

Hao Peng ◽

Ruiguo Dong ◽

...

Keyword(s):

Ischemic Stroke ◽

White Matter ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Hospital Discharge ◽

Scale Score ◽

Antihypertensive Treatment ◽

White Matter Hyperintensity ◽

Risk Of Death ◽

Increased Risk

Background and Purpose— It remains unknown that whether white matter hyperintensity (WMH) severity influences the effect of antihypertensive treatment in acute ischemic stroke. We aimed to investigate the effects of early antihypertensive treatment on death and disability among patients with acute ischemic stroke according to WMH severities. Methods— This study was a secondary analysis of the data from CATIS (China Antihypertensive Trial in Acute Ischemic Stroke). Severity of WMH was evaluated using Fazekas rating scale score among 303 participants with available magnetic resonance imaging data and was categorized into none-mild WMH (Fazekas score 0–2) and moderate-severe WMH (Fazekas score 3–6). Functional outcome was death or major disability (modified Rankin Scale score of ≥3) at 14 days or hospital discharge and within 3 months. Results— WMH severity was significantly associated with an increased risk of death or major disability. Each 1 score increase in Fazekas score was associated with an adjusted odds ratio (95% CI) of 1.25 (1.03–1.51) for 14 days or hospital discharge and 1.39 (1.12–1.72) for 3-month functional outcome. There were no significant interactions between antihypertensive treatment and WMH severity (both P >0.1) on functional outcome at 14 days or hospital discharge and within 3 months. The neutral effects of immediate antihypertensive treatment were observed both in patients with moderate-severe WMH and none-mild WMH. Conclusions— Participants with higher WMH burden had increased risk of death or major disability after acute ischemic stroke. Early antihypertensive treatment had a neutral effect on clinical outcomes among acute ischemic stroke patients with a variety of WMH severities. Registration— URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01840072.

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Thyroid-Stimulating Hormone, White Matter Hyperintensities, and Functional Outcome in Acute Ischemic Stroke Patients

Cerebrovascular Diseases Extra ◽

10.1159/000360217 ◽

2014 ◽

Vol 4 (1) ◽

pp. 61-68 ◽

Cited By ~ 8

Author(s):

Christopher O. Leonards ◽

Harald J. Schneider ◽

Thomas G. Liman ◽

Jochen B. Fiebach ◽

Matthias Endres ◽

...

Keyword(s):

Ischemic Stroke ◽

White Matter ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

White Matter Hyperintensities ◽

Thyroid Stimulating Hormone ◽

Stroke Patients ◽

Stimulating Hormone

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Abstract WP91: Cerebral Small Vessel Disease Burden Predicts Poor Collateral Flow in Acute Ischemic Stroke Patients With Large Artery Atherosclerosis

Stroke ◽

10.1161/str.51.suppl_1.wp91 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Yueming Wang ◽

Lumeng Yang ◽

Lan Hong ◽

Longting Lin ◽

Mark Parsons ◽

...

Keyword(s):

Ischemic Stroke ◽

White Matter ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Small Vessel Disease ◽

Flow Coefficient ◽

Collateral Flow ◽

Large Artery ◽

Stroke Patients ◽

Vessel Disease

Aim: We sought to determine whether the extent of chronic white matter hyper-intensities (WMH) and white matter hypo-perfusion (WMHP), as markers of cerebral small vessel disease (CSVD), were associated with poor collateral flow in acute ischemic stroke as a potential cause of unfavorable functional outcome. Methods: Acute ischemic stroke patients within 12 hours of symptom onset with complete baseline and follow-up clinical data, who: (1) had large vessel occlusion in anterior circulation, (2) underwent baseline perfusion CT (CTP), (3) had 24-hour MRI were prospectively recruited. The volume of WMH was measured in the unaffected hemisphere on MRI semi-automatically. WMHP was measured as Delay Time (DT)>2s in white matter of unaffected hemisphere on CTP. Quality of Collateral flow was defined by the volume ratio of DT>3s/DT>6s on CTP. Unfavorable functional outcome was 90-day modified Rankin Scale (mRS)>2. The association between volumes of WMH, WMHP, and collateral flow were evaluated using univariate and multivariate generalized linear models. We also assessed the relationship between WMH, WHMP, and functional outcome with logistic regression. Results: There were 96 (66.6±12.81 years old, 35 female) ischemic stroke patients, and 51 were due to large artery atherosclerosis (LAA). In all patients, after multivariate adjustment, WMH volume (5.6±7.11ml) did not correlate with collateral flow (coefficient -0.01, 95% CI -0.03 to 0, P=0.09), although it was marginally associated with unfavorable outcome (Odds Ratio: 1.08, p=0.06, 95% CI 1 to 1.17). In all patients, WMHP volume (8.6±8.54ml) did not correlate with collateral flow (coefficient -0.01, 95% CI -0.01 to 0, P=0.29). However, in the LAA subgroup, WMH volume was strongly related to poorer collateral flow, i.e. lower DT>3s/DT>6s ratio(coefficient -0.03, 95% CI -0.04 to -0.01, P=0.01). WMHP volume was also correlated with poor collateral flow (coefficient -0.01, 95% CI -0.02 to 0, P=0.02). Conclusion: CSVD may contribute to poor collateral flow in acute stroke, especially in patients with LAA. This potentially explains the association between CSVD and poor acute stroke outcomes.

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