White-matter lesions on CT in Alzheimer patients: relation to clinical symptomatology and vascular factors

Background and Purpose— Compared with other stroke causes, small-vessel disease is associated with better 3-month outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis. Another question is the impact of coexisting cerebral white matter lesions (WMLs; a surrogate marker of small-vessel disease) on outcome, which was addressed in the current study. Methods— We analyzed 2485 consecutive intravenous thrombolysis–treated patients at the Helsinki University Central Hospital, 2001 to 2014. WMLs were scored according to 4 previously published computed tomographic visual rating scales from all baseline head scans. The inter-rater agreement was calculated. The primary outcome measure was shift analysis, and the secondary examined all possible binary cutoffs in the modified Rankin Scale at 3 months. The associations of modified Rankin Scale with nominal, ordinal, and continuous variables were analyzed in univariate and adjusted in multivariate binary and ordinal regression (shift analysis) models. Results— In univariate and multivariate regression analyses, all 4 tested visual WML rating scales (as continuous variables, or dichotomized at different cutoff points) were associated with worse outcome at all binary levels and in shift analyses of the modified Rankin Scale. After adjusting for confounders, the statistically strongest association in shift analyses remained for the Blennow scale dichotomized at >3 points, reflecting at least moderate WMLs (odds ratio, 1.90; 95% confidence interval, 1.48–2.44). Conclusions— WMLs on admission computed tomographic scan are independently associated with worse outcome in intravenous thrombolysis–treated patients with stroke.

Section: Methodsmentioning

confidence: 99%

Cerebral Computed Tomography-Graded White Matter Lesions Are Associated With Worse Outcome After Thrombolysis in Patients With Stroke

Curtze

Melkas

Sibolt

et al. 2015

“…The modified van Swieten scale was initially calculated for this publication but was omitted because the results were redundant to the original van Swieten scale. 12,14,15 The 4 previously published CT visual rating scales for WMLs were scored by 8 experienced stroke neurologists from all baseline CT head scans in a blinded fashion without knowledge of patients' clinical data or outcome as previously described 12 : the Gorter scale, 16 the van Swieten scale, 17 the Blennow rating scale, 18 and the Wahlund rating scale. 19 The interclass correlation of raters (50 patients were rated by all 8 raters independently) indicated at least substantial agreement (defined as 0.61-0.80) for all 4 CT visual rating scales for WMLs as previously described.…”

Section: August 2015mentioning

confidence: 99%

White Matter Lesions Double the Risk of Post-Thrombolytic Intracerebral Hemorrhage

Curtze

Haapaniemi

Melkas

et al. 2015

Background and Purpose-Cerebral white matter lesions (WMLs), a surrogate for small-vessel disease, are common in patients with stroke and may be related to an increased intracranial bleeding risk after intravenous thrombolysis in acute ischemic stroke. We aimed to investigate the risk of symptomatic intracerebral hemorrhage (sICH) in the presence of WMLs in a large cohort of ischemic stroke patients treated with intravenous thrombolysis. Methods-We included 2485 consecutive patients treated with intravenous thrombolysis at the Helsinki University CentralHospital. WMLs were scored according to 4 previously published computed tomography visual rating scales from all baseline head scans. A sICH was classified according to the European Cooperative Acute Stroke Study II criteria. The associations of sICH with nominal, ordinal, and continuous variables were analyzed in a univariate binary regression model and adjusted in multivariate binary regression models. Results-In univariate and multivariate regression analyses, all 4 tested visual WML rating scales (as continuous variables or dichotomized at different cutoff points) were associated with increased risk of sICH. In binary analyses, WML doubled the bleeding risk: the odds ratios of all 4 visual rating scales ranged from 2.22 (95% confidence interval, 1.49-3.30) to 2.70 (1.87-3.90) in univariable and from 2.00 (1.26-3.16) to 2.62 (1.71-4.02) in multivariable analyses. The multivariableadjusted odds ratio for the association of high load of WMLs with remote parenchymal hemorrhage was 4.11 (2.38-7.10). Conclusions-WMLs visible on computed tomography are associated with a more than doubled risk of sICH in patients treated with intravenous thrombolysis for acute ischemic stroke.

“…Modified Blennow and Fazekas scale: a simple qualitative scale (absent, mild, moderate, or severe) based on the severity score of the Blennow scale for CT, 29 and a modified version of the Fazekas scale, 30 considering periventricular and deep white matter lesions altogether, for the MRI. 2.…”

Section: Assessment Of Wmcmentioning

confidence: 99%

Population-Based Case–Control Study of White Matter Changes on Brain Imaging in Transient Ischemic Attack and Ischemic Stroke

Simoni

Küker

et al. 2013

Background and Purpose-White matter changes (WMC) are a common finding on brain imaging and are associated with an increased risk of ischemic stroke. They are most frequent in small vessel stroke; however, in the absence of comparisons with normal controls, it is uncertain whether WMC are also more frequent than expected in other stroke subtypes. Therefore, we compared WMC in pathogenic subtypes of ischemic stroke versus controls in a populationbased study. Methods-We evaluated the presence and severity of WMC on computed tomography and on magnetic resonance brain imaging using modified Blennow/Fazekas scale and age-related white matter changes scale, respectively, in a population-