What Is the Significance of Leukoaraiosis in Patients With Acute Ischemic Stroke?

Abstract

LEUKOARAIOSIS (LA) is a term used to describe radiological abnormalities seen in the computed tomography (CT) of the brain in elderly patients as bilateral areas of hypodensity in the white matter of the cerebral hemispheres.¹ This nonspecific radiological sign is also shown by magnetic resonance imaging (MRI) findings.^2- 4 Leukoaraiosis may be associated with cognitive dysfunction in nondemented elderly subjects,^3- 5 but is also found in patients with Alzheimer disease, vascular dementia,^1,6- 8 and stroke.^1,9- 16 Hypodensity of the cerebral white matter can also be found in some healthy elderly subjects.¹³ The clinical relevance and pathogenesis of LA remain unclear. Results of pathological studies consistently linked LA with demyelination, gliosis, necrosis, and cavitation, which are associated with atherosclerosis of small or large vessels.^17,18 Similar pathologic features are found in arteriosclerotic vascular encephalopathy, or Binswanger disease.^19,20 Opinions differ regarding the outcome of stroke in patients with LA.^10,12- 15 Although most authors agree about the major role of hypertension in LA,^{10- 12,14,19- 21} conflicting opinions prevail concerning the potential causality of cardiac disease^{10,11,15,22,23} or diabetes mellitus.^10,11,22,24 However, all authors agree that frequency of LA increases with age.^{10,12- 15,22} Our study was designed to elucidate the relationship between risk factors, atherosclerosis of extracranial arteries visualized using Doppler sonography, causes and features of stroke, and early stroke outcome in patients with acute ischemic stroke (AIS) and coexisting LA.