Stratifying Future Stroke Risk with Incidentally- Discovered White Matter Disease Severity and Covert Brain Infarct...

Area of Science:

• Neurology
• Vascular Neurology
• Neuroimaging

Background:

• Covert cerebrovascular disease (CCD), encompassing white matter disease (WMD) and covert brain infarction (CBI), is linked to heightened stroke risk.
• The predictive value of WMD severity and CBI location for stroke risk remains unclear.

Purpose of the Study:

• To investigate the association between incidentally discovered WMD severity and CBI location and the risk of subsequent symptomatic stroke.

Main Methods:

• Retrospective cohort study of patients aged 50+ from Kaiser Permanente Southern California (2009-2019).
• Incidental WMD and CBI identified using natural language processing of neuroimaging reports.
• WMD severity classified into grades; CBI location determined.

Main Results:

• Over 261,000 patients underwent neuroimaging; 30% had WMD, 4.9% had CBI.
• Higher WMD severity correlated with increased stroke incidence, with CT showing higher rates than MRI at comparable severity levels.
• Subcortical infarcts comprised 97.9% of detected CBI; both cortical and subcortical CBI posed similar stroke risks.

Conclusions:

• Incidental WMD severity is a significant predictor of future stroke risk, with modality-dependent differences.
• CBI location (cortical vs. subcortical) does not appear to influence future stroke risk.