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White matter hyperintensity lesion burden is associated with the infarct volume and 90‐day outcome in small subcortical infarcts
Author(s) -
Helenius J.,
Mayasi Y.,
Henninger N.
Publication year - 2017
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/ane.12670
Subject(s) - medicine , etiology , modified rankin scale , hyperintensity , logistic regression , brain size , cardiology , magnetic resonance imaging , radiology , ischemic stroke , ischemia
Objectives Small subcortical infarcts ( SSI ) frequently coexist with brain white matter hyperintensity ( WMH ) lesions. We sought to determine whether preexisting WMH burden relates to SSI volume, SSI etiology, and 90‐day functional outcome. Materials and methods We retrospectively studied 80 consecutive patients with acute SSI . Infarct volume was determined on diffusion weighted imaging, and WMH burden was graded on fluid‐attenuated inversion recovery sequences according to the Fazekas scale. SSI etiology was categorized as small vessel disease ( SVD ) vs non‐ SVD related. Multivariable linear and logistic regression models were constructed to determine whether WMH burden was independently associated with the SSI volume and a poor 90‐day outcome (modified Rankin scale [ mRS ] score >2), respectively. Results In unadjusted analyses, patients with non‐ SVD ‐related SSI were older ( P =.002) and more frequently had multiple infarcts ( P <.001) than patients with SVD ‐related SSI . In the fully adjusted model, WMH severity (Coefficient 0.07; 95%‐ CI 0.029–0.117; P =.002) but not SSI etiology ( P >.1) was independently associated with the SSI volume. On multivariable logistic regression, worse WMH ( OR 2.28; 95%‐ CI 1.04–4.99; P =.040), SSI etiology ( OR 9.20; 95%‐ CI 1.04–81.39; P =.046), preadmission mRS ( OR 8.96; 95%‐ CI 2.65–30.27; P <.001), and SSI volume ( OR 1.98; 95%‐ CI 1.14–3.44; P =.016) were associated with a poor 90‐day outcome. Conclusions Greater WMH burden is independently associated with a larger SSI volume and a worse 90‐day outcome.