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MRI-assessed small vessel disease burden and gait performance in post-ischemic stroke hemiparesis
1Department of Rehabilitation, Akita Cerebrospinal and Cardiovascular Center, Akita Prefectural Hospital Organization, 6-10 Senshukubotamachi, Akita 010-0874, Japan.
Insights
Cerebral small vessel disease (SVD) burden independently impacts gait speed and step length in stroke survivors with hemiparesis, beyond motor deficits. This highlights SVD
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Cerebral small vessel disease (SVD) is common after ischemic stroke.
- Gait dysfunction is a significant issue in post-stroke hemiparesis.
Purpose of the Study:
- To investigate the independent association between SVD burden and gait performance in patients with post-ischemic stroke hemiparesis.
- To determine if SVD impacts gait beyond motor impairment severity.
Main Methods:
- Retrospective observational study of 126 ischemic stroke patients with hemiparesis.
- SVD burden assessed via MRI using STRIVE criteria (0-4 score).
- Gait parameters (speed, step length, cadence) measured using a 10-m walk test; analyzed with multivariable regression.
Main Results:
- Higher SVD burden independently correlated with reduced gait speed and shorter normalized step length.
- No independent association found between SVD burden and cadence.
- Findings persisted after adjusting for motor impairment severity and other clinical factors.
Conclusions:
- MRI-assessed SVD burden is an independent predictor of gait performance in post-stroke hemiparesis.
- Diffuse small vessel pathology contributes to gait dysfunction beyond focal motor deficits.
- SVD assessment may offer insights into gait recovery strategies.
Objective:
To examine whether cerebral small vessel disease (SVD) burden is independently associated with gait performance beyond motor impairment severity in patients with post-ischemic stroke hemiparesis.
Methods:
This retrospective observational study included 126 patients with ischemic stroke and hemiparesis who were able to walk at least 10 m independently. SVD burden was assessed on magnetic resonance imaging obtained within one week of stroke onset according to the STRIVE (Standards for Reporting Vascular Changes on Neuroimaging) criteria and summarized as a total SVD score (0-4). Gait speed, normalized step length, and cadence were measured at discharge using a 10-m maximal walk test. Multivariable linear regression analyses were performed adjusting for age, sex, lower-limb Brunnstrom Recovery Stage, sensory impairment, and Mini-Mental State Examination score. Sensitivity analyses evaluated potential interaction effects.
Results:
In adjusted models, higher SVD burden was independently associated with reduced gait speed (β = -0.19 for mild SVD and -0.33 for severe SVD) and shorter normalized step length (β = -2.89 for mild SVD and -5.87 for severe SVD), whereas cadence showed no independent association. These relationships persisted beyond motor impairment severity and were consistent in sensitivity analyses.
Conclusion:
MRI-assessed SVD burden is independently associated with gait performance in patients with post-ischemic stroke hemiparesis, suggesting that diffuse small vessel pathology contributes to gait dysfunction beyond focal motor deficits.
