Clinical impact of leukoaraiosis burden and chronological age on neurological deficit recovery and 90-day outcome after minor ischemic stroke

• Published in: Journal of the neurological sciences Vol. 359; no. 1; pp. 418 - 423
• Main Authors: Onteddu, Sanjeeva R, Goddeau, Richard P, Minaeian, Artin, Henninger, Nils
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.12.2015
• Subjects: Aged; Aged, 80 and over; Analysis of Variance; Brain frailty; Brain Ischemia - complications; Female; Follow-Up Studies; Humans; Ischemic stroke; Leukoaraiosis; Leukoaraiosis - diagnosis; Leukoaraiosis - drug therapy; Leukoaraiosis - etiology; Magnetic Resonance Imaging; Male; Middle Aged; Nervous System Diseases - drug therapy; Nervous System Diseases - etiology; Neurology; Old age; Outcome; Plasminogen Activators - therapeutic use; Recovery; Recovery of Function - physiology; Retrospective Studies; Severity of Illness Index; Small vessel disease; Statistics, Nonparametric; Stroke - complications; Stroke - etiology; Tomography, X-Ray Computed; TOAST; Trial of Org 10172 in Acute Stroke Treatment; rtPA; interquartile range; odds ratio; Ischemic stroke; Recovery; Old age; Small vessel disease; National Institutes of Health Stroke Scale; computed tomography; NIHSS; recombinant tissue plasminogen activator; OR; CI; van Swieten scale; IQR; LDLc; mRS; CT; modified Rankin scale; Outcome; VSS; Brain frailty; confidence interval; ΔNIHSS; Leukoaraiosis; low density lipoprotein cholesterol; NIHSS-improvement
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2015.10.005

Abstract Background and aims Ischemic stroke remains a leading cause of disability, particularly among the elderly, but this association has not been consistently noted among patients with minor stroke. We sought to determine the association of chronological age and leukoaraiosis, which is considered a marker of biological age, with the degree of neurological deficit recovery and 90-day disability after minor ischemic stroke. Methods We retrospectively analyzed 185 patients with a minor ischemic stroke (National Institutes of Health Stroke Scale [NIHSS] score ≤ 5). Leukoaraiosis severity was graded according to the van Swieten scale. NIHSS was assessed at baseline, discharge, and 90-days. Multivariable linear and ordinal logistic regression analyses were constructed to identify independent predictors of the degree of NIHSS-improvement (ΔNIHSS) and 90-day outcome as assessed by the modified Rankin Scale (mRS). Results Patients with severe leukoaraiosis had attenuated ΔNIHSS at 90 days as compared to patients with none-to-mild leukoaraiosis (p = 0.028). After adjustment, leukoaraiosis severity (p < 0.001) but not chronological age (p = 0.771) was independently associated with the ΔNIHSS by day 90. Severe leukoaraiosis (p = 0.003, OR 3.1, 95%-CI 1.5–6.4), older age (p = 0.001, OR 1.0 95%-CI 1.0–1.1), and admission NIHSS (p < 0.001, OR 1.5, 95%-CI 1.2–1.8) were independent predictors of the 90-day mRS. Conclusion Leukoaraiosis is a more sensitive predictor for neurological deficit recovery after ischemic stroke than chronological age. Further study is required to establish the specific contribution of leukoaraiosis to functional outcome after minor ischemic stroke beyond its impact on recovery mechanisms.