Possible Occurrence of Delayed Leukoencephalopathy Following Acute Ischemic Stroke With Large-Vessel Occlusion

Typically detected at least 14 days after acute ischemic stroke onset, delayed leukoencephalopathy (DL) involves diffuse hyperintensities restricted to white matter on fluid-attenuated inversion recovery accompanied mostly by partial diffusion-weighted image hyperintensities. DL cases, which are rarely reported, have occurred after large-vessel occlusion (LVO). Herein, we aim to elucidate the incidence and factors associated with DL.

Our study covers consecutive ischemic strokes involving: (1) onset-to-door time within 7 days and (2) available scans from at least a second magnetic resonance imaging procedure at least 14 days after onset. First, we examined the incidence of DL generally and whether LVO could be a risk factor for DL in ischemic strokes generally, and second, we examined the incidence and risk factors associated with DL in patients with LVO.

We screened 1857 consecutive patients with ischemic stroke and selected 792 general patients-573 (72%) men, median age 67 years-and 183 patients with LVO-128 (70%) men, median age 67 years. DL was detected in 2.3% of the general patients and 9.2% of the patients with LVO ischemic stroke. LVO was strongly associated with DL (odds ratio [OR], 69.1 [95 CI, 9.06-526]; P<0.001). Among patients with LVO, DL-associated factors were age/10 years (OR, 1.76 [95% CI, 1.13-2.75]; P=0.012), low-density lipoprotein cholesterol/10 mg/dL (OR, 0.863 [95% CI, 0.745-1.00]; P=0.049), complete recanalization (OR, not calculable; P<0.001), and endovascular therapy (OR, 17.4 [95% CI, 4.44-68.5]; P<0.001).

DL might not be rare following LVO. We speculate that certain risk factors and their combinations are key in the development of DL.