Periventricular and deep white matter changes as predictors of major acute ischemic stroke outcome.

OBJECTIVE Cerebral white matter changes (WMC) are considered indicative of small vessel diseases and are strongly associated with ischemic stroke outcomes in minor stroke populations. WMC are categorized into periventricular WMC (PVWMC) and deep subcortical WMC (DWMC), but their roles in major strokes remain unclear. Our study aims to investigate the specific roles of PVWMC and DWMC in predicting outcomes for major ischemic strokes. METHODS We enrolled a total of 316 patients with ischemic stroke admitted to the intensive care unit of the stroke center. Utilizing the Fazekas scale, we assessed PVWMC and DWMC scores and analyzed their association with changes in NIHSS scores and mortality rates. Additionally, we collected information on vascular risk factors to compare among groups with different Fazekas scores. RESULTS Among patients with major ischemic strokes, higher PVWMC scores, rather than DWMC scores, were significantly associated with changes in NIHSS scores (grading 2 and grading 3 to the mild PVWMC: OR 3.227, 95 % CI: 1.658, 6.280, P = 0.001; OR 6.090, 95 % CI: 2.296, 16.150, P < 0.001, respectively) and the mortality rate (grading 2 and grading 3 to the mild PVWMC: OR 14.244, 95 % CI: 2.040, 99.474, P = 0.007; OR 40.691, 95 % CI: 4.537, 364.928, P = 0.001, respectively). Aging, diabetes mellitus, hypertension, atrial fibrillation, a history of cerebrovascular accidents, and high NIHSS scores were linked to high-grade PVWMC. CONCLUSIONS In patients with major ischemic stroke, PVWMC serves as an independent predictor of in-hospital mortality and stroke progression, while DWMC does not. These findings enhance our understanding of the distinct roles of PVWMC and DWMC and contribute to the development of models for predicting major stroke outcomes.

• Publication year

  2025

• Venue

  Clinical neurology and neurosurgery (Dutch-Flemish ed. Print)

• Publication date

  2025-11-01

• Fields of study

  Medicine

• Identifiers
  DOI 10.1016/j.clineuro.2025.109232PMID 41240757
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

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