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Int J Stroke. 2018 Jul;13(5):518-524. doi: 10.1177/1747493017730780. Epub 2017 Sep 14.

The relation between total cerebral small vessel disease burden and gait impairment in patients with minor stroke.

Author information

1
1 Department of Neurology and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), University Maastricht, the Netherlands.
2
2 Brain Research Imaging Centre, Neuroimaging Sciences, Centre for Clinical Brain Sciences (CCBS), The University of Edinburgh, Edinburgh, UK.
3
3 Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, UK.
4
4 UK Dementia Research Institute at The University of Edinburgh, Edinburgh, UK.

Abstract

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.

KEYWORDS:

Cerebral small vessel disease; functional outcome; gait impairment; minor stroke; stroke impact scale; total cerebral small vessel disease burden

PMID:
28906203
DOI:
10.1177/1747493017730780

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