Brainstem leukoaraiosis independently predicts poor outcome after ischemic stroke

Area of Science:

• Neurology
• Radiology
• Stroke Medicine

Background:

• Increased supratentorial white matter hyperintensities volume (S-WMHV) is linked to worse outcomes in acute ischemic stroke (AIS).
• Limited research exists on brainstem white matter hyperintensities (B-WMH) and their impact on stroke outcomes.
• The relationship between B-WMH and S-WMHV requires further investigation.

Purpose of the Study:

• To investigate the association between brainstem white matter hyperintensities (B-WMH) and clinical outcomes in patients with AIS or transient ischemic attack (TIA).
• To determine if B-WMH independently predict poor outcomes after stroke.

Main Methods:

• Magnetic resonance imaging (MRI) was used to evaluate B-WMH in 313 prospectively identified AIS/TIA patients.
• Supratentorial white matter hyperintensities volume (S-WMHV) was quantified using volumetric analysis.
• Poor outcome was defined as a modified Rankin Scale score of 3-6 at 3 months post-event.

Main Results:

• Brainstem white matter hyperintensities (B-WMH) were present in 18.2% of patients.
• B-WMH were independently associated with unfavorable 90-day modified Rankin Scale scores (OR, 2.46; P = 0.021), even after adjusting for stroke severity and S-WMHV.
• Patients with B-WMH were older and had higher rates of hyperlipidemia and peripheral arterial disease.

Conclusions:

• Brainstem white matter hyperintensities (B-WMH) are an independent predictor of poor clinical outcomes following AIS/TIA.
• The presence of B-WMH suggests a distinct risk factor profile and potential differences in underlying pathogenesis.
• B-WMH should be considered in the prognostic assessment of stroke patients.