Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea.
Cerebrovasc Dis. 2013;35(2):138-45. doi: 10.1159/000346604. Epub 2013 Feb 7.
Many stroke survivors remain at a functionally disabled state. Early prediction of functional outcome is an important step in the treatment and care of stroke patients. Brain imaging measures have received particular attention as one of the predictors of stroke outcomes. However, the associations between white matter hyperintensities (WMHs) and post-stroke recovery have been controversial. This study aimed to investigate whether deep and periventricular WMHs (DWMHs and PVWMHs, respectively) were associated with functional outcomes at 2 weeks and 1 year after stroke separately and interactively.
A total of 408 patients were evaluated at the time of admission and 2 weeks after stroke, and 284 (78%) were followed 1 year later in order to evaluate consequences of stroke at both acute and chronic stages. Stroke outcomes were dichotomized into good and poor by applying a modified Rankin Scale (mRS) score cutoff of 1 (no significant disability)/2 (slight disability). Measures of stroke severity (National Institutes of Health Stroke Scale: NIHSS), physical disability (Barthel Index: BI), and cognitive function (Mini-Mental State Examination: MMSE) were administered. Brain magnetic resonance imaging (MRI) was performed at admission. DWMHs and PVWMHs were rated visually on axial FLAIR images using the 4-point modified Fazeka's scale and categorized into mild (grades 0 and 1) or severe (grades 2 and 3). The demographic and clinical covariates of age, gender, years of education, previous history of stroke, depression, stroke location, and vascular risk factors were obtained. Associations of WMHs with stroke outcomes (mRS) and other measures (NIHSS, BI, and MMSE) at 2 weeks and at 1 year after stroke were investigated using logistic regression and repeated measures ANOVA after adjustment for the potential covariates.
Severe PVWMHs, but not severe DWMHs, were significantly associated with worse outcomes both at 2 weeks and at 1 year after stroke. Furthermore, significant interactive effects of PVWMHs and DWMHs on poor outcomes were found. Significant PVWMH group by time interactions on NIHSS and BI scores, and significant group effects of both DWMHs and PVWMHs on MMSE score were found.
PVWMHs predicted poorer functional outcomes after stroke both in the acute and chronic phases, independently and interactively with DWMHs. In addition, PVWMHs were independently associated with worsening of stroke severity and physical disability. More careful evaluation and management of stroke patients with a high risk of functional dependence are indicated. Overall, PVWMH might be a prognostic marker of short- and long-term stroke outcomes.
许多中风幸存者仍处于功能障碍状态。对功能预后的早期预测是中风患者治疗和护理的重要步骤。脑影像学测量作为中风结果的预测因子之一受到了特别关注。然而，脑白质高信号（WMHs）与中风后恢复之间的关联一直存在争议。本研究旨在分别和交互地研究深部和脑室周围脑白质高信号（DWMHs 和 PVWMHs）与中风后 2 周和 1 年的功能结局是否相关。
共对 408 名患者在入院时和中风后 2 周进行评估，其中 284 名（78%）在 1 年后进行随访，以评估急性和慢性阶段中风的后果。中风结局通过应用改良 Rankin 量表（mRS）评分 1（无明显残疾）/2（轻度残疾）截断值分为良好和不良。测量中风严重程度（国立卫生研究院中风量表：NIHSS）、身体残疾（巴氏指数：BI）和认知功能（简易精神状态检查：MMSE）。入院时进行脑磁共振成像（MRI）检查。在轴向 FLAIR 图像上使用 4 分改良 Fazeka 量表对 DWMHs 和 PVWMHs 进行视觉评分，并将其分为轻度（0 级和 1 级）或重度（2 级和 3 级）。获得了年龄、性别、受教育年限、既往中风史、抑郁、中风部位和血管危险因素等人口统计学和临床协变量。使用逻辑回归和重复测量方差分析，在调整潜在协变量后，研究了 WMHs 与中风结局（mRS）和中风后 2 周和 1 年其他测量（NIHSS、BI 和 MMSE）之间的关联。
严重的 PVWMHs，但不是严重的 DWMHs，与中风后 2 周和 1 年的预后不良均显著相关。此外，还发现了 PVWMHs 和 DWMHs 对不良预后的显著交互作用。在 NIHSS 和 BI 评分上发现了显著的 PVWMH 组与时间的交互作用，以及 DWMHs 和 PVWMHs 对 MMSE 评分的显著组效应。
PVWMHs 独立且与 DWMHs 交互，预测中风后急性期和慢性期的功能结局更差。此外，PVWMHs 与中风严重程度和身体残疾的恶化独立相关。表明需要更仔细地评估和管理功能依赖性高的中风患者。总的来说，PVWMH 可能是中风短期和长期结局的预后标志物。
