Affiliation:
1. From the Center for Stroke Research Berlin (C.O.L., N.I., U.M., J.B.F., M. Endres, M. Ebinger), Klinik und Poliklinik für Neurologie (M. Endres, M. Ebinger), Charité–Universitätsmedizin, Berlin, Germany; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; German Center of Neurodegenerative Diseases (M. Endres), Charité–Universitätsmedizin Berlin, Berlin, Germany; German Center for Cardiovascular Research (M. Endres), Charité, Berlin, Germany.
Abstract
Background and Purpose—
To determine if severity of visually assessed white matter disease is associated with disability after ischemic stroke.
Methods—
In this Berlin “Cream & Sugar” substudy, all first ischemic stroke patients who received magnetic resonance imaging and completed follow-up between January 2009 and December 2010, were enrolled. Severity of white matter disease was assessed on fluid-attenuated inversion recovery or T2-weighted sequences using the Wahlund and Fazekas visual scales. Functional outcome was assessed after 1 year using the modified Rankin Scale (follow-up [FU] modified Rankin Scale [mRS]).
Results—
Of 101 patients (37% female; median age, 67 years; interquartile range, 54–75; National Institutes of Health Stroke Scale score, 1; interquartile range, 0–2), median FU mRS was 1 (interquartile range, 0–2). Binary logistical regression adjusted for age (at 5-year intervals), acute National Institutes of Health Stroke Scale scores, fasting glucose, insulin, glycosylated hemoglobin, creatinine, C-reactive protein quartiles, waist circumference, and systolic blood pressure revealed that Fazekas scores of 2 and 3 independently associated with FU mRS (Fazekas score 2: adjusted odds ratio, 8.4; 95% confidence interval, 2.35–30.09;
P
=0.001; Fazekas score 3: adjusted odds ratio, 4.2; 95% confidence interval, 1.04–16.96;
P
=0.044). Wahlund scores >10 were significantly associated with FU mRS when fasting glucose levels were removed from the regression analysis (adjusted odds ratio, 12.17; 95% confidence interval, 1.91–77.54;
P
=0.008).
Conclusion—
Severe white matter disease defined by standard criteria in acute ischemic stroke patients is associated with disability at 1 year and can be assessed quickly using visual rating scales.
Clinical Trial Registration Information—
URLs:
http://www.clinicaltrials.gov
and
https://eudract.ema.europa.eu
. Unique identifiers: NCT 01378468 and 2009-010356-97.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Advanced and Specialised Nursing,Cardiology and Cardiovascular Medicine,Clinical Neurology
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