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PROGNOSTIC VALUE OF WHITE MATTER CHANGES IN PATIENTS WITH TIA OR STROKE: A POPULATION-BASED STUDY
  1. M Simoni*,
  2. L Li,
  3. Z Mehta,
  4. PM Rothwell
  1. Nuffield Department of Clinical Neurosciences, University of Oxford

    Abstract

    Background White matter changes (WMC) on CT or MR brain imaging are common in TIA and stroke patients. Inconsistent associations, never so far researched in stroke and TIA population-based cohorts, have been reported between WMC and severity of stroke, disability, risk of recurrent stroke and death.

    Methods In consecutive TIA and stroke patients, semi-quantitatively rated WMC on CT and MRI, were related to premorbid disability (modified Rankin Score—mRS), baseline MMSE, risk of recurrent stroke, disability at 1 year and death during follow-up. Logistic and Cox regression analyses were adjusted for age, sex, and vascular risk factors.

    Results 1840 patients had MRI (520) and/or CT (1717). WMC were associated with worse premorbid mRS (OR for mRS>2, given WMC mod/severe on ARWMC scale=1.82, 95% CI 1.35 to 2.45, p=<0.0001) and with risk of worsening mRS at 1 year (OR=1.36, 1.02–1.83, p=0.04). Analyses of Barthel index domains showed associations with reduced pre-morbid mobility and continence. WMC were associated with baseline MMSE <24 (OR=1.71, 1.19–2.47, p=0.004) and with higher risk of death during follow-up, particularly in patients aged <75 years (adjusted HR=1.70, 1.08–2.67, p=0.02). No association emerged with recurrence of ischaemic stroke, although WMC did predict intracerebral haemorrhage (adjusted HR=2.83, 1.17–6.85, p=0.02).

    Conclusions In TIA or stroke patients, WMC are associated with pre-morbid disability and baseline cognitive impairment and predict progression of disability and risk of death at follow-up, independent of age, sex and vascular risk factors.

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