The severities of white matter lesions possibly influence the recurrences of several stroke types.
BACKGROUND
White matter lesions (WML) have been reported to be a surrogate marker of stroke occurrences. To investigate the recurrent stroke types associated with WML, we prospectively observed recurrences in stroke patients.


METHODS
We prospectively analyzed the types of stroke recurrence in 807 patients (351 women, 69.8 ± 12.0 years old) consecutively admitted to our hospital with strokes from April 2004 to October 2009. WML were graded using Fazekas grades. Recurrence-free rate curves were generated by the Kaplan-Meier method using the log-rank test.


RESULTS
The follow-up period was 31.6 ± 22.2 (range .5-71) months. During this period, 111 strokes recurred. The incidence of all stroke recurrences in 223 patients with grades 2 and 3 was 6.0% per year, which was significantly higher than that seen in 287 patients with grade 0 (2.1% per year, P = .006) and 297 patients with grade 1 (4.3% per year, P < .0001). The incidences of intracerebral hemorrhages (ICHs), lacunar infarctions, and atherothrombotic infarctions in patients with grades 2 and 3 were 1.2, 1.4, and 2.4% per year, respectively, which were higher than those seen in patients with grade 0 (.3%, P = .004; .2%, P = .002; and .9% per year, P = .010) but not similar to those in patients with grade 1 (.9%, P = .180; .9%, P = .161; and 1.4% per year, P = .249). There was no significant difference among grades 0, 1, 2, and 3 in incidence of stroke recurrences presenting as cardioembolic infarctions.


CONCLUSIONS
The presence of high-grade WML elevated the rate of stroke recurrences presenting as ICHs, lacunar infarctions, and atherothrombotic infarctions but not as cardioembolic infarctions.
Department of Neurosurgery, Kushiro City General Hospital, Kushiro, Hokkaido, Japan. Electronic address: timaizum@d9.dion.ne.jp.
Toshio
T
Imaizumi
Department of Neurosurgery, Kushiro City General Hospital, Kushiro, Hokkaido, Japan.
Shigeru
S
Inamura
Department of Neurosurgery, Kushiro City General Hospital, Kushiro, Hokkaido, Japan.
Tatsufumi
T
Nomura
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications; D020300:Intracranial Hemorrhages / Q000473:pathology; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000473:pathology*; D059409:Stroke, Lacunar / Q000473:pathology; D016896:Treatment Outcome; D066127:White Matter / Q000000981:diagnostic imaging / Q000473:pathology*
White matter lesions; macroangiopathy; microangiopathy; microbleeds; stroke recurrence