title: Leukoaraiosis predicts cortical infarct volume after distal middle cerebral artery occlusion.
abstract: OBJECTIVE
  Leukoaraiosis (LA) predominantly affects the subcortical white matter, but mounting evidence suggests an association with cortical microvascular dysfunction and potentially decreased cortical ischemic tolerance. Thus, we sought to assess whether preexisting LA is predictive of the cortical infarct volume after middle cerebral artery branch occlusion and whether it relates to a worse outcome.
  
  
  METHODS
  We analyzed data from 117 consecutive patients with middle cerebral artery branch occlusion as documented by admission computed tomography angiography. Baseline clinical, laboratory, and outcome data, as well as final cortical infarct volumes, were retrospectively analyzed from a prospectively collected database. LA severity was assessed on admission computed tomography using the van Swieten scale grading the supratentorial white matter hypoattenuation. Infarct volume predicting a favorable 90-day outcome (modified Rankin Scale score≤2) was determined by receiver operating characteristic curves. Multivariable linear and logistic regression analyses were used to identify independent predictors of the final infarct volume and outcome.
  
  
  RESULTS
  Receiver operating characteristic curve analyses indicated that a final infarct volume of ≤27 mL best predicted a favorable 90-day outcome. Severe LA (odds ratio, 11.231; 95% confidence interval, 2.526-49.926; P=0.001) was independently associated with infarct volume>27 mL. Severe LA (odds ratio, 3.074; 95% confidence interval, 1.055-8.961; P=0.040) and infarct volume>27 mL (odds ratio, 9.156; 95% confidence interval, 3.191-26.270; P<0.001) were independent predictors of a poor 90-day outcome (modified Rankin Scale, 3-6).
  
  
  CONCLUSIONS
  The presence of severe, subcortical LA contributes to larger cortical infarct volumes and worse functional outcomes adding to the notion that the brain is negatively affected beyond LA's macroscopic boundaries.
authors: From the Departments of Neurology (N.H., M.A.K., J.Z., M.M., R.P.G.) and Psychiatry (N.H.), University of Massachusetts Medical School, Worcester.
authors: Nils
authors: N
authors: Henninger
authors: Muhib A
authors: MA
authors: Khan
authors: Jiaying
authors: J
authors: Zhang
authors: Majaz
authors: M
authors: Moonis
authors: Richard P
authors: RP
authors: Goddeau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000473:pathology* / Q000628:therapy; D049292:Leukoaraiosis / Q000150:complications / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D011237:Predictive Value of Tests; D012372:ROC Curve; D020127:Recovery of Function; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: cerebral small vessel diseases; leukoaraiosis; stroke; stroke, lacunar