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Leukoencephalopathy in patients with ischemic stroke
Insights
Leukoencephalopathy, a white matter change, is common in ischemic stroke patients, especially with deep infarcts. Hypertension is a key risk factor, suggesting it
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Leukoencephalopathy, characterized by diffuse white matter hypodensity on CT, is observed in ischemic stroke patients.
- This condition is more prevalent in patients with deep cerebral infarcts compared to cortical infarcts.
Purpose of the Study:
- To investigate the prevalence and clinical associations of leukoencephalopathy in acute ischemic stroke patients.
- To determine the relationship between leukoencephalopathy, infarct topography, cognitive impairment, and vascular risk factors.
Main Methods:
- Systematic investigation of 1,000 ischemic stroke patients using computed tomography (CT), Doppler, electrocardiography (ECG), and biological tests.
- Comparison of patients with leukoencephalopathy to matched controls without leukoencephalopathy.
- Assessment of cognitive function and vascular risk factors including hypertension, carotid artery stenosis, diabetes, and hypercholesterolemia.
Main Results:
- Leukoencephalopathy was identified in 3.1% of ischemic stroke patients, significantly more frequent in those with deep infarcts (8%) than cortical infarcts (0.8%).
- Patients with leukoencephalopathy exhibited higher rates of progressive intellectual impairment and dementia compared to controls.
- Hypertension was the most common risk factor and was more frequent in patients with leukoencephalopathy; conversely, carotid artery stenosis was less frequent.
Conclusions:
- Leukoencephalopathy in acute stroke patients is not a coincidental finding and is strongly associated with hypertension.
- Hypertension appears to be more closely linked to leukoencephalopathy than to deep infarcts.
- The presence of leukoencephalopathy warrants further investigation into underlying vascular risk factors, particularly hypertension.
Abstract:
Thirty-one (16 women, 15 men; mean age 68 years) of 1,000 consecutive patients with an ischemic stroke investigated systematically with computed tomography (CT), Doppler, electrocardiography (ECG), and biological tests had a diffuse hypodensity of the cerebral hemispheric white matter on CT, a sign indicative of leukoencephalopathy. In 25 of the 31 patients, the acute infarct was deep. Leukoencephalopathy was more frequent in patients with a deep infarct (8%) than in patients in whom the cortex was involved (0.8%) (p less than 0.01). A history of progressive intellectual impairment (23%) and the finding of a mild or moderate impairment, or severe dementia (84%) were more frequent in study patients (p less than 0.05) than in 31 sex- and age-matched controls with an acute infarct of same size and topography but without leukoencephalopathy. A history of hypertension (81%) and high blood pressure on admission (166 +/- 19/96 +/- 12 mm Hg) were the most common risk factors and were more frequent in study patients (p less than 0.05) than in controls. On the other hand, study patients had a greater than or equal to 50% stenosis or occlusion of the carotid artery (13%) less often than controls (35%) (p less than 0.05). Diabetes (23%), elevated blood cholesterol (13%), hematocrit greater than 45% (23%), smoking (32%), and myocardial ischemia by history or ECG (45%) did not differ. These findings suggest that hypertension may be more strongly associated with leukoencephalopathy than with deep infarcts. In acute stroke patients, leukoencephalopathy on CT should not be considered a fortuitous finding.