Abstract 141: Leukoaraiosis is Associated with Impaired Functional Recovery and Outcome after Mild Ischemic Stroke

Abstract

OBJECTIVE: To determine whether leukoaraiosis (LA) severity is an independent risk factor for impaired functional recovery and outcome after mild ischemic stroke. METHODS: We retrospectively analyzed data from 185 consecutive patients admitted to a single tertiary care stroke center with mild ischemic stroke (National Institutes of Health Scale [NIHSS] score ≤5). LA severity was graded from 0 (absent) to 4 (severe) using the van Swieten scale (VSS). LA was also dichotomized in 0-2 (absent to moderate) vs. 3-4 (severe). NIHSS was assessed at admission, discharge, and 90 days. Lastly, infarct volumes were measured in a subset of patients with available MRI (n=153). Multivariable ordinal logistic regression analyses were used to identify independent predictors of an excellent 90 days outcome (modified Rankin Score [mRS] ≤1). RESULTS: Severe leukoaraiosis was independently associated with a poor outcome in patients with mild ischemic stroke (OR 3.1, 95% CI 1.5-6.4; p=0.003; Figure 1A). Interestingly, patients with severe LA had smaller infarct volumes than those with absent to moderate LA (Figure 1B). Further, at the time of admission, NIHSS did not differ between LA-severities (Figure 1C). However, patients with severe LA had less complete improvement by 90-days as assessed by the NIHSS. CONCLUSIONS: Among patients with minor stroke sever LA is independently associated with a poor 90-day outcome despite having smaller infarct volumes and similar deficits at the time of presentation as patients with absent-to-moderate LA. Together with the observed less complete NIHSS-improvement these results indicate that LA negatively affects cerebral plasticity and recovery.