Chronic Covert Brain Infarctions and White Matter Hyperintensities in Patients With Stroke, Transient Ischemic Attack, and Stroke Mimic

Abstract

Background This study was conducted to compare frequencies of chronic brain infarctions (CBIs) and white matter hyperintensities (WMHs) as well as their associations with established early recurrence risk scores in patients with transient ischemic attack (TIA) and stroke mimics compared with ischemic stroke. Methods and Results Single‐center cohort study including consecutive patients with TIA, stroke mimics, and acute ischemic stroke, with available magnetic resonance imaging from January 2015 to December 2017. Blinded raters adjudicated WMH (age‐related white matter changes score) and CBI according to established definitions. A total of 2112 patients (median [Q1–Q3] age 71 [59–80] years, 43% women, National Institutes of Health Stroke Scale score of 2 [1–7], 80% ischemic stroke, 18% TIA, 2% stroke mimics) were included. While CBIs were present in only 10% of patients with stroke mimic, they were detected in 28% of TIAs and 38% of ischemic strokes ( P <0.001). WMHs were less pronounced (0, 0–1) in patients with stroke mimic, but there was no difference between TIA (1, 1–2) and ischemic stroke (0, 1–2) patients. CBIs (adjusted odds ratio, 0.3; 95% CI, 0.1–0.9) were associated with a lower rate of stroke mimic as the final diagnosis, while WMHs were not (adjusted odds ratio per point, 1.3; 95% CI, 0.7–2.2). WMH (β per point, 0.4; 95% CI, 0.3–0.6) and presence of CBI (β, 0.6; 95% CI, 0.3–0.9) were associated with a higher cardiovascular risk profile according to the ABCD3‐I score. The accuracy of prediction was good for high‐risk TIA (cross‐validated area under the receiver operating characteristic curve, 0.89; 95% CI, 0.79–0.93) on the basis of brain imaging, age, and sex. Conclusions CBI and WMH differ between patients with stroke mimic and patients with TIA/ischemic stroke and are closely associated with established recurrence risk scores. Prospective studies need to clarify whether including brain frailty markers may contribute to the refinement of current management algorithms and risk stratifications.

Association of covert brain infarct phenotype with stroke recurrence in first-ever manifest ischemic stroke according to etiology

“…CBI phenotypes and locations were identified in accordance with recent studies in this field, 10,11 utilizing a classification proposed by Vynckier et al 13 : CBI were classified as cavitatory (lesions ⩾3mm in diameter with central cavity and adjacent gliosis), combined gray and white matter lesions, isolated gray matter lesions and large subcortical (noncavitatory) infarcts (Supplemental Figure 1). 13 The cavitatory phenotype corresponds to the STRIVE definition of lacune of presumed vascular origin, but also includes cerebellar lesions.…”

“…Data pooling was approved by the ethics committee of the Medical University of Graz (EK 29-285 ex 16/17; informed consent was obtained by all included subjects) and Bern (ID 2020-01696, requirement for informed consent was waived according to Swiss law) and performed according to the standards of Declaration of Helsinki. 11 Reporting was performed according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Data from this study are available from the corresponding author upon reasonable request.…”

Characterizing upper extremity fine motor function in the presence of white matter hyperintensities: A 7 T MRI cross-sectional study in older adults

“…White matter hyperintensities (WMH) are one of the structural changes, measured as signal hyperintensities on T2-weighted and T2-fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) images ( Wardlaw et al, 2015 ). They are frequently encountered in the scans of elderly people, and may represent a major risk factor for diseases including but not limited to stroke ( Aamodt et al, 2021 , Schellhorn et al, 2021 , Epstein et al, 2022 , Longstreth et al, 2001 , Schellhorn et al, 2021 , Aamodt et al, 2021 , Vermeer et al, 2003 ), dementia ( Alber et al, 2019 ), mild cognitive impairment ( Prins and Scheltens, 2015 , Wardlaw et al, 2019 ) and Alzheimer’s disease (AD) ( Hu et al, 2021 ) along with an additional reduction in the long-term outcomes, negative interaction with disease prognosis and recurrence ( Aamodt et al, 2021 , Schellhorn et al, 2021 , Hu et al, 2021 , Longstreth et al, 2001 , Vermeer et al, 2003 , Zerna et al, 2020 ). In this framework, understanding how WMH impact brain function in a healthy elderly population among different domains could provide insights about how these lesions add to and interact with the processes of aging as well as several neurological diseases.…”

Lipid remodeling in serum and correlation with stroke in patients with leukoaraiosis

“…Previous research has established LA as an imaging marker for small vessel disease, potentially serving as a risk factor for stroke and unfavorable clinical outcomes [8,9]. Furthermore, a study has identi ed the existence of white matter hyperintensities as a robust prognostic indicator for early recurrence after acute ischemic stroke [10]. Lacunar cerebral infarcts and LA are commonly encountered in patients presenting with transient ischemic attack (TIA) and ischemic stroke.…”