Abstract
Background and PurposeThe evolution of total brain volume early after stroke is not well understood. We investigated the associations between age and imaging features and brain volume change in the first month after stroke.MethodsWe retrospectively studied patients with acute ischemic stroke enrolled in the AXIS-2 trial. Total brain volume change from hyperacute MRI data to the first month after stroke was assessed using unified segmentation in SPM12. We hypothesized that age, ischemic brain lesion size, and white matter (WM) changes were associated with larger brain volume change. Enlarged perivascular spaces (EPVSs) and white matter hyperintensities (WMHs) were rated visually and the presence of lacunes was assessed.ResultsWe enrolled 173 patients with a mean age of 67 ± 11 years, 44% were women. There was a median 6 ml decrease in volume (25th percentile −1 ml to 75th percentile 21 ml) over time, equivalent to a median 0.5% (interquartile range [IQR], −0.07%−1.4%), decrease in brain volume. Age was associated with larger brain volume loss (per 10 years of age, 5 ml 95% CI 2–8 ml). Baseline diffusion weighted imaging (DWI) lesion volume was not associated with greater volume loss per 10 ml of lesion volume, change by 0 ml (95% CI −0.1 to 0.1 ml). Increasing Fazekas scores of deep WMH were associated with greater tissue loss (5 ml, 95% CI 1–10 ml).ConclusionsTotal brain volume changes in a heterogenous fashion after stroke. Volume loss occurs over 1 month after stroke and is associated with age and deep WM disease. We did not find evidence that more severe strokes lead to increased early tissue loss.
Highlights
Cerebral atrophy is the end result of chronic or acute insults affecting the brain and commonly occurs with aging and stroke
The baseline age, National Institutes of Health Stroke Scale (NIHSS) score, diffusion weighted imaging (DWI) lesion volume, and follow-up modified Rankin scale (mRS) score at 90 days were different between the patients who were included in this study and the excluded patients
The follow up magnetic resonance imaging (MRI) was obtained at 31 days (IQR 29–33 days)
Summary
Cerebral atrophy is the end result of chronic or acute insults affecting the brain and commonly occurs with aging and stroke. One may hypothesize that volume changes may be more prominent in larger strokes, where tissue loss is extensive in the area of the insult. These larger strokes may be associated with more edema and hemorrhagic transformation, with resultant increases in volume, especially in the first few days and weeks after stroke. Cerebral small vessel disease and age are associated with accelerated brain volume changes, when patients are studied serially after stroke [5,6,7,8,9,10,11]. We investigated the associations between age and imaging features and brain volume change in the first month after stroke
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