Leukoaraiosis correlates with the neurologic deterioration after small subcortical infarction

Abstract

Background: Patients of small subcortical infarction sometimes have neurologic deterioration (ND), with the risk factors and specific pathogenesis unclear. Small subcortical infarction is often accompanied by other phenotypes of small vessel disease such as leukoaraiosis, which indicates the white matter hyperintensities in the deep or periventricular areas on the fluid-attenuated inversion recovery series of magnetic resonance images and was proved to be associated with stroke in various aspects. In this study, we intended to investigate whether leukoaraiosis was associated with ND after small subcortical infarction, and explore other possible risk factors of ND.

Methods: Patients with single acute subcortical infarction (<1.5 cm in diameter) were recruited consecutively and evaluated everyday. ND was defined as worsening by 2 points or more in the National Institutes Health Stroke Scale (NIHSS) score, or by 1 point or more in the NIHSS score for motor function within 1 week after stroke onset. Leukoaraiosis was rated according to the age-related white matter changes scale. Univariate and multivariate analyses were performed to identify the risk factors for ND.

Results: Eighty-four of 435 patients (19.31%) had ND. Univariate analysis showed that age, severity of leukoaraiosis, baseline NIHSS score, presence of diabetes, hemoglobin A1c, and total cholesterol levels were all associated with ND. Multivariate analysis further identified that the severity of leukoaraiosis especially leukoaraiosis adjacent to the index infarction, baseline NIHSS score, and diabetes were independently associated with ND.

Conclusions: Severity of leukoaraiosis and baseline neurologic deficits, and the presence of diabetes were all independently associated with ND after small subcortical infarction.

Keywords: Small subcortical infarction; leukoaraiosis; neurologic deterioration; small vessel disease.