title: White matter lesion severity in mild acute ischemic stroke patients and functional outcome after 1 year.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  URLs: http://www.clinicaltrials.gov and https://eudract.ema.europa.eu. Unique identifiers: NCT 01378468 and 2009-010356-97.
authors.affiliation: Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Campus Mitte, Charité Platz 1, D-10117 Berlin, Germany.
authors.forename: Christopher O
authors.initials: CO
authors.lastname: Leonards
authors.forename: Nils
authors.initials: N
authors.lastname: Ipsen
authors.forename: Uwe
authors.initials: U
authors.lastname: Malzahn
authors.forename: Jochen B
authors.initials: JB
authors.lastname: Fiebach
authors.forename: Matthias
authors.initials: M
authors.lastname: Endres
authors.forename: Martin
authors.initials: M
authors.lastname: Ebinger
mesh_terms: D000368:Aged; D001921:Brain / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D020127:Recovery of Function; D020521:Stroke / Q000473:pathology*; D016896:Treatment Outcome