Abstract Details

Title White Matter Hyperintensity Pattern Predicts Stroke Etiology

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (12:00 PM-1:00 PM)

Poster/Presentation
Number 4-020

Objective The objective of the study is to test the following hypothesis: stroke due to AF has a different WMH pattern in comparison to SVD, representing a different mechanism.

Background Classification of stroke subtypes includes cardioembolism (CE) and small vessel disease (SVD), and may have distinct radiographic traits. The Fazekas scale is used to quantify severity of subcortical white matter hyperintensities (WMH). A single center retrospective study concluded in patients with CE stroke and atrial fibrillation (AF), a specific WMH pattern secondary to a cardiovasculopathy exists, but excluded SVD patients. Another single center retrospective study theorized that juxtacortical small lesions (JCSL) may be secondary to arteriole atherosclerosis or microemboli. Pattern and location of WMH may serve to delineate between ischemic stroke subtypes.

Design/Methods 167 patients with ischemic stroke due to AF and SVD were retrospectively identified from an academic medical center between July 2018 and June 2019. Patient demographics were collected and T2 FLAIR sequences were scored using the Fazekas scale and by presence or lack of periventricular, deep subcortical, and JCSLs. Univariate and multivariate analyses were performed. Large artery atherosclerosis (intra and extracranial) was excluded due to potential for exhibiting patterns of both deep WMH and JCSL.

Results Univariate analysis noted that the AF group had lower Fazekas score (2 vs 3, p=0.002), less deep subcortical WMH (79% vs 93%, p=0.006), and higher JCSL (86% vs 63%, p=0.0009) when compared with the SVD group. Stepwise logistic regression showed that patients with lower Fazekas score (OR=0.53, 95% CI=[0.38, 0.75], p=0.0002) and JCSL presence (OR=3.64, 95% CI=[1.29,10.32], p=0.02) were more likely to be in the AF group.

Conclusions WMH pattern in patients with AF is different than patients with SVD, with less deep WMH, and more JCSL, supporting cardioembolization as mechanism.

Authors/Disclosures
Piotr Bzdyra, MD PRESENTER	No disclosure on file
Bichun Ouyang	Bichum Ouyang has nothing to disclose.
Laurel J. Cherian, MD, FAAN (Rush University Medical Center)	The institution of Dr. Cherian has received research support from NIH.
Rima Dafer, MD (Rush University Medical Center)	Dr. Dafer has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly. Dr. Dafer has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Eli Lilly. Dr. Dafer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Anderson, Rasor, and partners.
Nicholas D. Osteraas, MD (Rush University Med Center)	Dr. Osteraas has nothing to disclose.
James Conners, MD (Rush University Medical Center)	The institution of Dr. Conners has received research support from nih.
Sarah Song, MD, MPH, FAAN (Rush University Medical Center)	Dr. Song has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN.
Alejandro Vargas, MD, MS, FAAN (Rush University Medical Center)	Dr. Vargas has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer U.S. LLC Pharmaceuticals.