title: White matter hyperintensity lesion burden is associated with the infarct volume and 90-day outcome in small subcortical infarcts.
abstract: OBJECTIVE
  Small subcortical infarcts (SSI) frequently coexist with brain white matter hyperintensity (WMH) lesions. We sought to determine whether preexisting WMH burden relates to SSI volume, SSI etiology, and 90-day functional outcome.
  
  
  METHODS
  We retrospectively studied 80 consecutive patients with acute SSI. Infarct volume was determined on diffusion weighted imaging, and WMH burden was graded on fluid-attenuated inversion recovery sequences according to the Fazekas scale. SSI etiology was categorized as small vessel disease (SVD) vs non-SVD related. Multivariable linear and logistic regression models were constructed to determine whether WMH burden was independently associated with the SSI volume and a poor 90-day outcome (modified Rankin scale [mRS] score >2), respectively.
  
  
  RESULTS
  In unadjusted analyses, patients with non-SVD-related SSI were older (P=.002) and more frequently had multiple infarcts (P<.001) than patients with SVD-related SSI. In the fully adjusted model, WMH severity (Coefficient 0.07; 95%-CI 0.029-0.117; P=.002) but not SSI etiology (P>.1) was independently associated with the SSI volume. On multivariable logistic regression, worse WMH (OR 2.28; 95%-CI 1.04-4.99; P=.040), SSI etiology (OR 9.20; 95%-CI 1.04-81.39; P=.046), preadmission mRS (OR 8.96; 95%-CI 2.65-30.27; P<.001), and SSI volume (OR 1.98; 95%-CI 1.14-3.44; P=.016) were associated with a poor 90-day outcome.
  
  
  CONCLUSIONS
  Greater WMH burden is independently associated with a larger SSI volume and a worse 90-day outcome.
authors: Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA.
authors: J
authors: J
authors: Helenius
authors: Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA.
authors: Y
authors: Y
authors: Mayasi
authors: Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA.|Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA.
authors: N
authors: N
authors: Henninger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D002544:Cerebral Infarction / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D066127:White Matter / Q000000981:diagnostic imaging* / Q000473:pathology
keywords: diffusion weighted imaging; infarction; magnetic resonance imaging; small subcortical infarction; white matter hyperintensity