title: Leukoaraiosis and sex predict the hyperacute ischemic core volume.
abstract: OBJECTIVE
  Leukoaraiosis (LA) and male sex have been associated with decreased cerebrovascular reactivity, which potentially adversely affects tissue viability in acute stroke. Therefore, we aimed to elucidate the contribution of LA-severity and sex to the extent of the hyperacute ischemic core volume after intracranial large artery occlusion.
  
  
  METHODS
  We analyzed data from 87 patients with acute intracranial large artery occlusion who had acute multimodal computed tomography-imaging. LA-severity was assessed using the van Swieten scale on noncontrast computed tomography. Computed tomography perfusion data were analyzed using automatic calculation of the mean transit time and hyperacute cerebral blood volume defects. Multivariate linear and logistic regression analyses were used to identify independent predictors of the hyperacute infarct-volume.
  
  
  RESULTS
  Severe LA (van Swieten Scale, 3-4; odds ratio, 43.22; 95% CI, 6.26-298.42; P<0.001) and male sex (odds ratio, 7.52; 95% CI, 1.38-40.86; P=0.020) were independently associated with a hyperacute cerebral blood volume-lesion >25 mL on multivariate logistic regression analysis. Multivariate linear regression analysis confirmed the association between severe LA (P<0.001) and male sex (P=0.01) with larger cerebral blood volume-lesions. There was no significant difference in the absolute or relative mean transit time-lesion volumes when stratified by LA-severity or sex. Women had significantly smaller cerebral blood volume-lesion volumes compared with men (P=0.036).
  
  
  CONCLUSIONS
  Severe LA and male sex are associated with larger infarct cores, which adds to the notion that sex and LA alter the brain's intrinsic susceptibility to acute cerebral ischemia. Future, larger studies are needed to confirm our observation that women have smaller core volumes and its significance.
authors.affiliation: Department of Neurology, University of Massachusetts Medical School, 55 Lake Ave, N Worcester, MA 01655, USA. nils.henninger@umassmed.edu
authors.forename: Nils
authors.initials: N
authors.lastname: Henninger
authors.forename: Eugene
authors.initials: E
authors.lastname: Lin
authors.forename: Diogo C
authors.initials: DC
authors.lastname: Haussen
authors.forename: Laura L
authors.initials: LL
authors.lastname: Lehman
authors.forename: Deepak
authors.initials: D
authors.lastname: Takhtani
authors.forename: Magdy
authors.initials: M
authors.lastname: Selim
authors.forename: Majaz
authors.initials: M
authors.lastname: Moonis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000473:pathology* / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D006801:Humans; D049292:Leukoaraiosis / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012727:Sex Characteristics