Abstract TP134: White Matter Disease and Patterns of Infarction: A Single Center Study

Abstract

Background: Patterns of acute cerebral infarction can often reveal the underlying mechanism of ischemic injury. Despite the strong overlap between vascular risk factors and embolic infarct mechanisms (with multifocal infarct patterns), acute multifocal subcortical infarcts may be related to microangiopathic changes. Methods: A prospective stroke registry was queried for patients with acute infarction in >1 vascular territory on diffusion-weighted imaging (unrelated to any endovascular procedure). The odds of a multi-infarct subcortical pattern (vs. cortical pattern) were estimated for patients with higher Fazekas grade (2-3) versus low grade (0-1) patients using forward stepwise logistic regression with greatest minimization of corrected Akaike information criterion including all demographic covariates. Results: Out of 746 patients with acute infarcts and complete covariate data, 226 patients (30.3%) had a multi-infarct pattern, of whom 113 (50.0%) had high grade (Fazekas 2-3) white matter disease. Compared to patients with grade 0-1 Fazekas score, those with grade 2-3 more frequently had multifocal subcortical infarcts (4.4% vs. 10%, p=0.01). Following multivariable adjustment, the odds of multifocal subcortical infarcts were greater for patients with higher Fazekas grades (adjusted odds ratio [OR] 2.9, 95% confidence interval [CI] 1.3-6.7). The higher odds of multifocal subcortical infarcts were observed in a stepwise fashion for each Fazekas grade when compared to grade 0 (adjusted OR for grade 3 10.1, 95% CI 1.2-84; grade 2 OR 9.4, 95% 1.2-75.6; grade 1 OR 4.9, 95% 0.6-40.4). Conclusions: In this single center analysis we found that white matter burden is correlated with subcortical patterns of multifocal cerebral infarction. This suggests such infarcts may be caused by uncontrolled vascular risk factors rather than a proximal embolic source when chronic white matter disease is present.