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Periventricular and deep white matter changes as predictors of major acute ischemic stroke outcome

Ying-Sheng Li1, Chung-Yao Hsu2, Meng-Ni Wu2

  • 1Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Neurology, Kaohsiung Medical University Gangshan Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.

Clinical Neurology and Neurosurgery
|November 15, 2025
PubMed
Abstract

Insights

Periventricular white matter changes (PVWMC) predict major ischemic stroke progression and mortality, unlike deep subcortical white matter changes (DWMC). This research clarifies PVWMC and DWMC roles in major stroke outcomes.

Area of Science:

  • Neurology
  • Vascular Neurology
  • Neuroimaging

Background:

  • Cerebral white matter changes (WMC) are linked to small vessel diseases and stroke outcomes.
  • WMC are classified as periventricular (PVWMC) and deep subcortical (DWMC).
  • The distinct roles of PVWMC and DWMC in major ischemic stroke outcomes are not well understood.

Purpose of the Study:

  • To investigate the independent predictive values of PVWMC and DWMC for outcomes in major ischemic stroke patients.
  • To analyze the association of PVWMC and DWMC with stroke progression and mortality.

Main Methods:

  • A cohort of 316 major ischemic stroke patients was studied.
  • The Fazekas scale was used to assess PVWMC and DWMC.
  • Associations between WMC scores, NIHSS score changes, and mortality rates were analyzed.

Main Results:

  • Higher PVWMC scores, but not DWMC scores, significantly predicted NIHSS score changes and mortality.
  • Factors associated with high-grade PVWMC included aging, diabetes, hypertension, atrial fibrillation, prior stroke, and high NIHSS scores.

Conclusions:

  • PVWMC are independent predictors of in-hospital mortality and stroke progression in major ischemic stroke.
  • DWMC do not independently predict outcomes in this population.
  • Findings aid in developing predictive models for major stroke outcomes.
Keywords:
Cerebral white matter changesMajor ischemic strokeMortalityNeurocritical careStroke deterioration

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