Abstract W P157: Radiographic Markers of Small Vessel Disease in Young Stroke Patients.

Abstract

Background: White-matter hyperintensities (WMH) and cerebral microbleeds (CMBs) are considered radiographic markers of small vessel disease (SVD). Literature on CMB and WMH prevalence and associated risk factors in young patients presenting with stroke is limited. We have reported high prevalence of both WMH and CMBs in our cohort of young stroke patients. The aim of this report is to better characterize independent determinants of WMH and CMBs in the same cohort Methods: Charts of consecutive patients ≤49 years of age admitted with a diagnosis of ischemic stroke (IS) or spontaneous intraparenchymal hemorrhage (IPH) between 01/06-02/10 were reviewed (n=146). Patients with interpretable T2*-GRE (104) and/or T2/FLAIR (107) sequences on MRI were eligible. WMH was graded according to the Age-Related White Matter Changes Scale, and cerebral volume using the Global Cortical Atrophy Scale. Using multivariable regression analysis, we compared baseline demographics and vascular risk factors between patients with MRI markers of SVD and those without. Results: CMBs were present in 17% and moderate-severe WMH in 27% of individuals. Male gender (OR 4.93 [95%CI 1.01, 24.1]), hypertension (HTN) (OR 8.84 [95%CI 1.76, 40.5]), moderate-severe WMH (OR 5.25 [95%CI 1.54, 17.9]), and IPH (OR 6.97 [95%CI 1.81, 26.8]) were independently associated with the presence of CMBs. CMBs (OR 4.27 [95% CI 1.35, 13.5]), HTN (OR 4.14 [95% CI 1.42, 12.1]), serum creatinine on admission (OR per 1 mg/dl increment: 3.02 [95% CI 1.14, 7.99]) and moderate-severe cortical atrophy (OR 6.26 [95% CI 1.40, 27.94]) were significantly associated with moderate-severe WMH. Conclusions: Our data suggest male gender, HTN, IPH and moderate-severe WMH are associated with CMBs, while HTN, CMBs, elevated serum creatinine and moderate-severe cortical atrophy are associated with moderate-severe WMH. The association of CMBs with higher WMH severity and IPH supports the notion that CMBs are an indicator of an advanced stage of SVD that is prone to bleeding. Further studies are needed to examine if presence of CMBs and/or WMH may impact outcomes after ischemic stroke in young adults.