Leukoaraiosis is associated with pneumonia after acute ischemic stroke

Nam, Ki‐Woong; Kwon, Hyung‐Min; Lim, Jae Sung; Lee, Yong Seok

doi:10.1186/s12883-017-0830-5

Cited by 27 publications

(11 citation statements)

References 22 publications

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“…The summed Fazekas score was categorized into two groups with scores 0-2 and 3-6. 40,41 The WMH volume used in the analyses excluded the peritumoral edema and was de ned as the sum of the volume of periventricular WMH and deep WMH. Age and WMH volume were analysed as continuous variables.…”

Section: Discussionmentioning

confidence: 99%

Patients with Pretreatment Leukoencephalopathy and Older Patients have More Cognitive Decline after Whole Brain Radiotherapy

Chan

Ferguson

Mhurchu

et al. 2020

Preprint

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Purpose: To investigate predictors of cognitive decline after whole brain radiotherapy (WBRT) for brain metastases. Methods: A secondary analysis of a phase 2 clinical trial was conducted in patients who received stereotactic radiosurgery for 1-10 brain metastases and WBRT (NCT01046123). The Montreal Cognitive Assessment (MoCA) was performed at baseline and every three months after WBRT. Baseline T2-weighted fluid attenuation inversion recovery magnetic resonance imaging was independently assessed by two neuroradiologists for the presence of white matter hyperintensities (WMH) using the Fazekas visual rating scale. WMH were also manually segmented for volumetric analysis. Univariable and multivariable logistic regression were used to test the association between baseline variables and MoCA score decline. Results: Forty-six patients survived ≥3 months after treatment. Age (OR 1.12 (1.04 – 1.21, p < 0.01), baseline WMH volume (OR 1.20, 95% CI 1.06 – 1.52, p = 0.02) and baseline Fazekas score ≥ 3/6 (OR 6.4, 95% CI 1.7 – 24.7, p < 0.01) were predictive of MoCA score decline. In multivariable analysis, age was the only significant predictor of MoCA decline. However, all three patients with pre-treatment leukoencephalopathy (Fazekas score = 6/6) had notable adverse outcomes due to cognitive impairment: one required full-time home nursing support and two were institutionalized.Conclusion: A greater decline in cognition after WBRT was observed in older patients and patients with a higher baseline WMH burden. Although this study is small and hypothesis-generating, we propose that radiation oncologists should exercise caution in prescribing WBRT if leukoencephalopathy is present on pre-treatment imaging.

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Section: Discussionmentioning

confidence: 99%

Patients with Pretreatment Leukoencephalopathy and Older Patients have More Cognitive Decline after Whole Brain Radiotherapy

Chan

Ferguson

Mhurchu

et al. 2020

Preprint

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“…WMH was rated on fluid‐attenuated inversion recovery images using the Fazekas scale in peri‐ventricular and subcortical areas, respectively . We then summed up the score in two areas and dichotomized into mild (0–2) and severe (3–6) WMH . CMB was counted as presence or absence on gradient echo image in both lobar and deep areas.…”

Section: Methodsmentioning

confidence: 99%

“…MRI, magnetic resonance imaging; TIA, transient ischaemic attack. areas and dichotomized into mild (0-2) and severe (3-6) WMH [21]. CMB was counted as presence or absence on gradient echo image in both lobar and deep areas.…”

Section: Evaluation Of Neuroimaging Findingsmentioning

confidence: 99%

Clinical relevance of abnormal neuroimaging findings and long‐term risk of stroke recurrence

Nam

Kwon

Lim

et al. 2017

Euro J of Neurology

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“…The summed Fazekas score was categorized into two groups with scores 0-2 and 3-6. 34,35 The WMH volume used in the analyses excluded the peritumoral edema and was de ned as the sum of the volume of periventricular WMH and deep WMH. Age and WMH volume were analysed as continuous variables.…”

Section: Anova Eta Was Used To Test Association Between Fazekas Scorementioning

confidence: 99%

Patients with Pretreatment Leukoencephalopathy and Older Patients have More Cognitive Decline after Whole Brain Radiotherapy

Chan

Ferguson

Mhurchu

et al. 2020

Preprint

View full text Add to dashboard Cite

Purpose: To investigate predictors of cognitive decline after whole brain radiotherapy (WBRT) for brain metastases. Methods: A secondary analysis of a phase 2 clinical trial was conducted in patients who received stereotactic radiosurgery for 1-10 brain metastases and WBRT (NCT01046123). The Montreal Cognitive Assessment (MoCA) was performed at baseline and every three months after WBRT. Baseline T2-weighted fluid attenuation inversion recovery magnetic resonance imaging was independently assessed by two neuroradiologists for the presence of white matter hyperintensities (WMH) using the Fazekas visual rating scale. WMH were also manually segmented for volumetric analysis. Univariable and multivariable logistic regression were used to test the association between baseline variables and MoCA score decline. Results: Forty-six patients survived ≥3 months after treatment. Age (OR 1.12 (1.04 – 1.21, p < 0.01), baseline WMH volume (OR 1.20, 95% CI 1.06 – 1.52, p = 0.02) and baseline Fazekas score ≥ 3/6 (OR 6.4, 95% CI 1.7 – 24.7, p < 0.01) were predictive of MoCA score decline. In multivariable analysis, age was the only significant predictor of MoCA decline. However, all three patients with pretreatment leukoencephalopathy (Fazekas score = 6/6) had notable adverse outcomes due to cognitive impairment: one required full-time home nursing support and two were institutionalized. Conclusion: A greater decline in cognition after WBRT was observed in older patients and patients with a higher baseline WMH burden. Although this study is small, we propose that a Fazekas score of 6 should be a relative contraindication to WBRT. Trial Registration: clinicaltrials.gov identifier NCT01046123. First posted January 11, 2010. https://clinicaltrials.gov/ct2/show/NCT01046123

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Leukoaraiosis is associated with pneumonia after acute ischemic stroke

Cited by 27 publications

References 22 publications

Patients with Pretreatment Leukoencephalopathy and Older Patients have More Cognitive Decline after Whole Brain Radiotherapy

Patients with Pretreatment Leukoencephalopathy and Older Patients have More Cognitive Decline after Whole Brain Radiotherapy

Clinical relevance of abnormal neuroimaging findings and long‐term risk of stroke recurrence

Patients with Pretreatment Leukoencephalopathy and Older Patients have More Cognitive Decline after Whole Brain Radiotherapy

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