Department of Neurology, Helsinki University Central Hospital, Haartmaninkatu 4, FIN-00290, Helsinki, Finland.
Neurology. 2011 May 17;76(20):1742-9. doi: 10.1212/WNL.0b013e31821a44ad.
To investigate prognostic relevance of silent brain infarcts (SBIs) and leukoaraiosis (LA) in young patients with ischemic stroke.
This observational cohort study included consecutive MRI-scanned patients aged 15 to 49 with first-ever ischemic stroke treated at Helsinki University Central Hospital (1994-2007) with long-term follow-up data available. Outcome measures were 1) nonfatal or fatal ischemic stroke, 2) composite vascular endpoint, and 3) death from any cause. Trial of ORG 10172 in Acute Stroke Treatment (TOAST) and Bamford criteria allowed for stroke subtyping. Number of SBIs was categorized into none, single, or multiple. LA fell into groups of none, mild, or moderate to severe (validated visual rating scale).
The 655 patients (mean age 40.0 ± 8.0 years) included were followed for a mean 8.7 ± 3.8 years (survivors). Of the 86 (13.1%) patients with SBIs, 46 had single and 40 had multiple SBIs. In the 50 (7.6%) patients with LA, these changes were mild in 21 and moderate to severe in 29. In Cox regression analysis, multiple SBIs independently raised the risk for recurrent ischemic stroke (odds ratio 2.48; 95% confidence interval 1.24-4.94) adjusted for age, gender, risk factors, stroke etiology, and LA. After further adjustment for initial stroke severity, TOAST and Bamford subgroups, and presence of SBIs, moderate to severe LA increased the risk for death (3.43; 1.58-7.42). Neither SBIs nor LA associated with the composite vascular endpoint.
MRI-defined SBIs and LA are prognostically valuable in young adults after their first-ever ischemic stroke.
研究无症状性脑梗死（SBI）和脑白质疏松症（LA）在年轻缺血性脑卒中患者中的预后相关性。
本观察性队列研究纳入了在赫尔辛基大学中心医院（1994-2007 年）接受治疗的年龄在 15 至 49 岁的首次发生缺血性脑卒中且具有长期随访数据的连续 MRI 扫描患者。主要转归指标为：1）非致死性或致死性缺血性脑卒中；2）复合血管终点；3）任何原因导致的死亡。组织型纤溶酶原激活物治疗急性脑卒中试验（TOAST）和班福德标准允许对脑卒中进行亚型分类。SBI 的数量分为无、单发或多发。LA 分为无、轻度和中重度（经过验证的视觉评分量表）。
655 例患者（平均年龄 40.0 ± 8.0 岁）平均随访 8.7 ± 3.8 年（幸存者）。86 例（13.1%）患者存在 SBI，其中 46 例为单发，40 例为多发。50 例（7.6%）患者存在 LA，其中 21 例为轻度改变，29 例为中重度改变。在 Cox 回归分析中，多灶性 SBI 与复发性缺血性脑卒中独立相关（比值比 2.48；95%置信区间 1.24-4.94），校正年龄、性别、危险因素、脑卒中病因和 LA 后。进一步调整初始脑卒中严重程度、TOAST 和班福德亚组以及 SBI 存在后，中重度 LA 增加了死亡风险（3.43；1.58-7.42）。SBI 和 LA 均与复合血管终点无关。
在年轻的首次缺血性脑卒中患者中，MRI 定义的 SBI 和 LA 具有预后价值。
