Cathra Halabi, MD, Anthony S. Kim, MD reviewing Kongbunkiat K et al. Neurology 2017 Feb 14.
Leukoaraiosis is associated with an increased risk for symptomatic intracerebral hemorrhage and poor functional outcomes after acute stroke thrombolysis.

Leukoaraiosis (LA) is a manifestation of ischemic and inflammatory changes to the small arteries and arterioles of the brain and is characterized by local endothelial dysfunction, vessel wall remodeling, and loss of autoregulation. Given this pathologic substrate and the association of LA with cognitive and neurorehabilitative impairment, there have been lingering concerns about whether LA may confer an increased risk for symptomatic intracerebral hemorrhage (sICH) and for poorer functional outcome after acute stroke thrombolysis.

Researchers have now synthesized data from 15 studies and 6967 patients to evaluate whether LA is predictive of sICH or poor functional outcome after acute stroke thrombolysis. The overall pooled prevalence of LA was 42.1%, the overall sICH risk after thrombolysis (assessed in 10 studies) was 5.4%, and 60.8% of patients from 11 studies had poor functional outcomes (modified Rankin Scale score ≥2) at 3 months. Any LA at baseline was associated with a 2.5% absolute increase in sICH risk (6.6% vs. 4.1%) and a 15.4% absolute increase in risk for poor functional outcome (68.0% vs. 52.6%), while moderate-to-severe LA was associated with a 6.2% absolute increase in sICH (10.2% vs. 4.0%) and a 17.5% absolute increase in poor outcomes compared with no or mild LA (76.0% vs. 58.5%).

CITATION(S):

Kongbunkiat K et al. Leukoaraiosis, intracerebral hemorrhage, and functional outcome after acute stroke thrombolysis. Neurology 2017 Feb 14; 88:638. 

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