1 Department of Neurology and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), University Maastricht, the Netherlands.
2 Brain Research Imaging Centre, Neuroimaging Sciences, Centre for Clinical Brain Sciences (CCBS), The University of Edinburgh, Edinburgh, UK.
Int J Stroke. 2018 Jul;13(5):518-524. doi: 10.1177/1747493017730780. Epub 2017 Sep 14.
Background and aims Individual MRI markers of cerebral small vessel disease are associated with gait impairment. The impact of total cerebral small vessel disease-related brain damage, expressed by a cerebral small vessel disease MRI burden score, on mobility after stroke, has not been considered, although this score gives a better representation of the overall effect of cerebral small vessel disease on the brain. We determined if the total cerebral small vessel disease burden is associated with gait impairment three years after minor stroke. Methods In total, 200 patients with minor lacunar or non-lacunar stroke (NIHSS ≤ 7) underwent a brain MRI at presentation. Presence of lacunes, white matter hyperintensities, cerebral microbleeds, and perivascular spaces were summed in a total cerebral small vessel disease MRI burden score (range 0-4). Gait disturbances, measured by timed-up-and-go test and self-reported stroke impact scale mobility domain were assessed three years after stroke. We tested associations adjusted for key variables by linear regression analysis. Results Total cerebral small vessel disease burden was not associated with gait impairment after minor stroke in all patients, nor in lacunar stroke patients ( n = 87). In non-lacunar stroke patients ( n = 113), total cerebral small vessel disease burden was associated with lower stroke impact scale mobility domain scores, independent of age, vascular risk factors, and stroke severity (unstandardized B -4.61; 95% CI -8.42; -0.79, p < 0.05). Conclusion Patients with non-lacunar stroke and a higher total cerebral small vessel disease burden have more subjective mobility impairment three years after stroke. The total cerebral small vessel disease MRI burden score is a possible marker to identify patients at risk for subjective gait impairment. These findings should be confirmed in larger studies.
脑小血管病的个体 MRI 标志物与步态障碍有关。尽管脑小血管病 MRI 负担评分能更好地反映脑小血管病对大脑的整体影响，但尚未考虑到总脑小血管病相关脑损伤对中风后活动能力的影响。我们旨在确定轻度中风后 3 年，总脑小血管病负担与步态障碍之间的关系。
共 200 例轻度腔隙性或非腔隙性卒中（NIHSS≤7）患者在发病时接受了脑部 MRI 检查。腔隙、脑白质高信号、脑微出血和血管周围间隙的存在在总脑小血管病 MRI 负担评分（范围 0-4）中进行了总结。中风后 3 年，通过计时起立行走测试和自我报告的中风影响量表活动域评估步态障碍。我们通过线性回归分析调整关键变量后测试了相关性。
在所有患者以及腔隙性卒中患者（n=87）中，总脑小血管病负担与轻度卒中后步态障碍无关。在非腔隙性卒中患者（n=113）中，总脑小血管病负担与中风影响量表活动域评分较低独立相关，与年龄、血管危险因素和卒中严重程度无关（未标准化 B -4.61；95%CI -8.42；-0.79，p<0.05）。
非腔隙性卒中且总脑小血管病负担较高的患者，中风后 3 年主观活动能力受损更严重。总脑小血管病 MRI 负担评分可能是识别有主观步态障碍风险患者的标志物。这些发现需要在更大的研究中得到证实。
