White Matter Lesion Severity in Mild Acute Ischemic Stroke Patients and Functional Outcome After 1 Year

Background and Purpose-To determine if severity of visually assessed white matter disease is associated with disability after ischemic stroke. Methods-In this Berlin Cream & Sugar substudy, all first ischemic stroke patients who received magnetic resonance imaging and completed follow-up between January 2009 and December 2010, were enrolled. Severity of white matter disease was assessed on fluid-attenuated inversion recovery or T2-weighted sequences using the Wahlund and Fazekas visual scales. Functional outcome was assessed after 1 year using the modified Rankin Scale (follow-up [FU] modified Rankin Scale [mRS]). Results-Of 101 patients (37% female; median age, 67 years; interquartile range, 54-75; National Institutes of Health Stroke Scale score, 1; interquartile range, 0-2), median FU mRS was 1 (interquartile range, 0-2). Binary logistical regression adjusted for age (at 5-year intervals), acute National Institutes of Health Stroke Scale scores, fasting glucose, insulin, glycosylated hemoglobin, creatinine, C-reactive protein quartiles, waist circumference, and systolic blood pressure revealed that Fazekas scores of 2 and 3 independently associated with FU mRS (Fazekas score 2: adjusted odds ratio, 8.4; 95% confidence interval, 2.35-30.09; P=0.001; Fazekas score 3: adjusted odds ratio, 4.2; 95% confidence interval, 1.04-16.96; P=0.044). Wahlund scores >10 were significantly associated with FU mRS when fasting glucose levels were removed from the regression analysis (adjusted odds ratio, 12.17; 95% confidence interval, 1.91-77.54; P=0.008). Conclusion-Severe white matter disease defined by standard criteria in acute ischemic stroke patients is associated with disability at 1 year and can be assessed quickly using visual rating scales. Clinical Trial Registration Information-URLs: http://www.clinicaltrials.gov and https://eudract.ema.europa.eu. Unique identifiers: NCT 01378468 and 2009-010356-97. (Stroke. 2012;43:3046-3051.)