What is the significance of leukoaraiosis in patients with acute ischemic stroke?
BACKGROUND
Leukoaraiosis (LA) may have specific clinical correlates in patients with stroke, but this is not well investigated, so that the significance of LA in patients with stroke remains unclear.


METHODS
In a study of 2289 patients with a first-ever acute ischemic stroke, LA was noted in 149 by the use of baseline computed tomography of the brain. These patients were compared with the non-LA group. Statistical tests, including Fisher exact test or a chi(2) test, were used to compare variables, and a multivariate approach using stepwise logistic regression was performed.


RESULTS
Patients with LA were significantly older (73.7 vs 62.7 years; P<. 001), and had a higher incidence of hypertension (72.5% vs 47.1%; P<. 001) and subcortical or lacunar infarction (40.3% vs 25.4% and 21.5% vs 8.0%, respectively; P<.001) on neuroimaging studies, compared with the non-LA group. The most common cause of stroke in the LA group was presumed to be small-artery disease associated with hypertension (46% vs 13.5% in the non-LA group). Age and hypertension were very strongly associated with LA (respective odds ratios [95% confidence intervals], 1.06 [1.04-1.08] and 2.33 [1.60-3. 39]). In addition to these risk factors, a close relationship was found between LA and nonsevere stenosis (<50%) of the internal carotid artery (odds ratio, 2.23 [95% confidence interval, 1.32-3. 76]), although the significance of this association remains speculative. The outcome at 1 month after stroke was similar in both groups.


CONCLUSIONS
Our results provide further evidence that LA is related primarily to small-vessel disease.
Wiszniewska
M
M
Department of Neurology, CHUV (BH 07) rue du Bugnon 46, 1011 Lausanne, Switzerland.
Devuyst
G
G
Bogousslavsky
J
J
Ghika
J
J
van Melle
G
G
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001259:Ataxia / Q000453:epidemiology; D001921:Brain / Q000098:blood supply / Q000473:pathology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000000981:diagnostic imaging; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019636:Neurodegenerative Diseases / Q000175:diagnosis / Q000453:epidemiology*; D016017:Odds Ratio; D010291:Paresis / Q000453:epidemiology; D011379:Prognosis; D012307:Risk Factors; D017678:Sex Distribution; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology*; D014463:Ultrasonography; D014711:Vertebral Artery / Q000000981:diagnostic imaging