| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From the Section of Neurology (Drs. Briley, Haroon and Thomas, and S.M. Sergent), Department of Medicine, Marshall University School of Medicine, and Huntington VAMC, Huntington, WV.
Address correspondence and reprint requests to Dennis P. Briley, Department of Neurology (J21), Stoke Mandeville Hospital NHS Trust, Mandeville Road, Aylesbury, Bucks HP21 8AL, UK; e-mail: dbriley{at}nildram.co.uk
OBJECTIVE: To determine whether leukoaraiosis predicts morbidity and mortality.
BACKGROUND: Gait disturbance and leukoaraiosis both are common in the elderly. Gait disturbance predicts mortality. Leukoaraiosis may be a unifying factor to both gait disturbance and mortality.
METHODS: We followed 221 patients prospectively evaluated for severity of neurologic deficits by the National Institutes of Health (NIH) stroke scale and for leukoaraiosis in seven brain regions by CT, graded as absent (n = 119, 54%), mild (in at least one of seven brain regions; n = 54, 24%), or severe (present in all seven brain regions; n = 48, 22%). Pneumonia (n = 27, 12%), falls resulting in fracture requiring hospitalization (n = 7, 3%), and death (n = 38, 17%) were end points.
RESULTS: Severe leukoaraiosis predicted death (Cox hazard ratio [HR] = 2.91; 95% CI = 1.5 - 5.6), pneumonia (HR = 5.1; 95% CI = 2.4 - 10.9), death from pneumonia (HR = 8.3; 95% CI = 1.5 - 46), and falls (HR = 6.8; 95% CI = 1.5 - 30). Severe leukoaraiosis predicted a combined end point of death, pneumonia, and falls (HR = 3.5; 95% CI = 2 - 6). Other predictors were NIH stroke scale score, age, smoking, diabetes, gait score, and referral diagnosis of either dementia or Parkinsonism. Severe leukoaraiosis remained a predictor after adjustment for these other factors (HR = 2.2; 95% CI = 1.2 - 3.9), but was borderline after adjusting for gait (HR = 1.96; 95% CI = 0.97 - 3.94; p = 0.061). The combination of severe leukoaraiosis and gait disturbance had the highest risk (HR = 4.4; 95% CI = 2.4 - 7.9).
CONCLUSION: Severe leukoaraiosis predicts morbidity and mortality independently of preexisting neurologic deficits. The combination of leukoaraiosis and gait disturbance carries a poor prognosis.
Key words: Leukoaraiosis—Stroke—Gait—Cerebral ischemia
This article has been cited by other articles:
|
|
 |
|
  L. Pantoni Leukoaraiosis: From an Ancient Term to an Actual Marker of Poor Prognosis Stroke, May 1, 2008; 39(5): 1401 - 1403. [Full Text] [PDF]
|
|
|
|
 |
|
 M. O'Sullivan Leukoaraiosis Practical Neurology, January 1, 2008; 8(1): 26 - 38. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M.-C. Corti, G. Baggio, L. Sartori, G. Barbato, E. Manzato, E. Musacchio, L. Ferrucci, G. Cardinali, D. Donato, L. J. Launer, et al. White Matter Lesions and the Risk of Incident Hip Fracture in Older Persons: Results From the Progetto Veneto Anziani Study Arch Intern Med, September 10, 2007; 167(16): 1745 - 1751. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P.K. Myint, K.E.S. Poole, and E.A. Warburton Hip fractures after stroke and their prevention QJM, September 1, 2007; 100(9): 539 - 545. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Lin, L. Svensson, R. Gupta, B. Lytle, and D. Krieger Chronic ischemic cerebral white matter disease is a risk factor for nonfocal neurologic injury after total aortic arch replacement J. Thorac. Cardiovasc. Surg., April 1, 2007; 133(4): 1059 - 1065. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. F. Hoth, D. F. Tate, A. Poppas, D. E. Forman, J. Gunstad, D. J. Moser, R. H. Paul, A. L. Jefferson, A. P. Haley, and R. A. Cohen Endothelial Function and White Matter Hyperintensities in Older Adults With Cardiovascular Disease Stroke, February 1, 2007; 38(2): 308 - 312. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F.-E. de Leeuw, E. Korf, F. Barkhof, and P. Scheltens White Matter Lesions Are Associated With Progression of Medial Temporal Lobe Atrophy in Alzheimer Disease Stroke, September 1, 2006; 37(9): 2248 - 2252. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. D. Hill and J. D. Bisognano Leukoaraiosis: The brain under pressure: Target for treatment? Neurology, June 14, 2005; 64(11): 1832 - 1833. [Full Text] [PDF]
|
|
|
|
 |
|
 J H Fu, C Z Lu, Z Hong, Q Dong, Y Luo, and K S Wong Extent of white matter lesions is related to acute subcortical infarcts and predicts further stroke risk in patients with first ever ischaemic stroke J. Neurol. Neurosurg. Psychiatry, June 1, 2005; 76(6): 793 - 796. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. M. Moody, C. R. Thore, J. A. Anstrom, V. R. Challa, C. D. Langefeld, and W. R. Brown Quantification of Afferent Vessels Shows Reduced Brain Vascular Density in Subjects with Leukoaraiosis Radiology, December 1, 2004; 233(3): 883 - 890. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. E. Smith, M. E. Gurol, J. A. Eng, C. R. Engel, T. N. Nguyen, J. Rosand, and S. M. Greenberg White matter lesions, cognition, and recurrent hemorrhage in lobar intracerebral hemorrhage Neurology, November 9, 2004; 63(9): 1606 - 1612. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. van der Grond, A. F. van Raamt, Y. van der Graaf, W. P.T.M. Mali, and R. H.C. Bisschops A fetal circle of Willis is associated with a decreased deep white matter lesion load Neurology, October 26, 2004; 63(8): 1452 - 1456. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H.-K. Kuo and L. A. Lipsitz Cerebral White Matter Changes and Geriatric Syndromes: Is There a Link? J. Gerontol. A Biol. Sci. Med. Sci., August 1, 2004; 59(8): M818 - M826. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Jeerakathil, P. A. Wolf, A. Beiser, J. Massaro, S. Seshadri, R. B. D'Agostino, and C. DeCarli Stroke Risk Profile Predicts White Matter Hyperintensity Volume: The Framingham Study Stroke, August 1, 2004; 35(8): 1857 - 1861. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Inzitari Leukoaraiosis: An Independent Risk Factor for Stroke? Stroke, August 1, 2003; 34(8): 2067 - 2071. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Briley Older people with impaired mobility have specific loci of periventricular abnormality on MRI Neurology, June 11, 2002; 58(11): 1704 - 1704. [Full Text] [PDF]
|
|
|
|
|
|
J. Y. Streifler, M. Eliasziw, O. R. Benavente, S. Alamowitch, A. J. Fox, V. C. Hachinski, and H. J.M. Barnett Prognostic Importance of Leukoaraiosis in Patients With Symptomatic Internal Carotid Artery Stenosis Stroke, June 1, 2002; 33(6): 1651 - 1655. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H Yamauchi, H Fukuda, and C Oyanagi Significance of white matter high intensity lesions as a predictor of stroke from arteriolosclerosis J. Neurol. Neurosurg. Psychiatry, May 1, 2002; 72(5): 576 - 582. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Havlik, D. J. Foley, B. Sayer, K. Masaki, L. White, and L. J. Launer Variability in Midlife Systolic Blood Pressure Is Related to Late-Life Brain White Matter Lesions: The Honolulu-Asia Aging Study Stroke, January 1, 2002; 33(1): 26 - 30. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Helenius, L. Soinne, O. Salonen, M. Kaste, and T. Tatlisumak Leukoaraiosis, Ischemic Stroke, and Normal White Matter on Diffusion-Weighted MRI Stroke, January 1, 2002; 33(1): 45 - 50. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Yamamoto, I. Akiguchi, K. Oiwa, M. Hayashi, T. Kasai, and K. Ozasa Twenty-four-Hour Blood Pressure and MRI as Predictive Factors for Different Outcomes in Patients With Lacunar Infarct Stroke, January 1, 2002; 33(1): 297 - 305. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Verpillat, A. Alperovitch, F. Cambien, V. Besancon, H. Desal, and C. Tzourio Aldosterone synthase (CYP11B2) gene polymorphism and cerebral white matter hyperintensities Neurology, March 13, 2001; 56(5): 673 - 675. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. C. Hiner, M. Earnhart, T. Yamamoto, S. Frucht, W. J. Weiner, S. A. Factor, O. Rascol, and The 056 Study Group Ropinirole as Compared with Levodopa in Parkinson's Disease N. Engl. J. Med., September 21, 2000; 343(12): 884 - 885. [Full Text]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
