Introduction The explanation for the prognostic value of the ABCD2-score remains uncertain. If it genuinely measures cerebral susceptibility to ischaemia, it should correlate with other markers of susceptibility, such as leukoaraiosis (LA). We studied the association of the ABCD2-score with the severity of LA in a large cohort of patients with TIA or minor stroke.

Methods Consecutive patients attending a TIA-clinic were recruited and underwent routine MR-imaging (T2/DWI). Detailed clinical data were obtained and the ABCD2 score calculated. Two independent observers assessed the presence and severity of LA with standard rating scales.

Results 671 patients (56% men; mean age=71 (SD=11) years) with TIA (45%) or minor stroke attended the clinic. LA was more prevalent (p=0.015) and more severe (p=0.007) in patients with stroke vs TIA. LA was associated with lesion presence on DWI (p<0.0001) and history of prior stroke (p=0.026). LA and the ABCD2-score were strongly associated (p<0.0001), due mainly to association of LA with age (p<0.0001), with motor symptoms at presentation (p<0.0001) and with hypertension (p=0.001). Associations were similar in analyses stratified by diagnosis and adjusted for age.

Conclusion The associations of LA with prior stroke, presenting stroke and with lesion presence on DWI confirm it as a marker of cerebral susceptibility to ischaemia. The strong association of the ABCD2-score with LA may therefore at least partly explain its prognostic value.