Relationship between Leukoaraiosis, Carotid artery atherosclerosis and neurological recovery in acute stroke patients: A cross-sectional Study

Abstract

Leukoaraiosis (LA), is associated with increased age, hypertension, and history of stroke. Although several lines of evidence suggest a role of atherosclerosis in atherothrombotic vascular events, their involvement in LA remains to be determined. Current study examines this association in ischemic stroke patients, and the impact of leukoaraiosis on neurological recovery. The current study was conducted among seventy consecutive patients admitted to stroke unit in Ain Shams University Specialized Hospital with acute ischemic stroke during the first 48 hours after onset. Their age is less than 65 years. The patients was diagnosed as having leukoaraiosis by MRI done on admission. At the beginning of the assessment, subjects were requested for demographic data and data concerned with gender, special focus on risk factors of atherosclerosis like smoking, dyslipidemia, diabetes, hypertension, sedentary life style also family history of coronary artery disease or stroke. The current study aimed to investigate whether there is a significant relation between carotid artery atherosclerosis with the development of leukoaraiosis and its impact on neurological recovery in acute ischemic stroke patients. The study subjects were investigated by basic laboratory data including, random blood sugar level, two hours post prandial, fasting blood sugar, serum glycosylated hemoglobin percentage, lipid profile, uric acid, ESR, serum albumin, kidney function tests and liver function tests. In addition to basic cardiological investigations which included Echocardiography highlighting the ejection fraction, left atrial diameter and the presence or absence of segmental wall motion abnormalities. The degree of leukoaraiosis was determined using the Fazekas scale, leukoaraiosis (white matter hyperintensity [WMH]) was graded as 1 (mild), 2 (moderate) or 3 (severe) for all participants. The initial deficit and the prognosis of the studied subjects were estimated using the NIHSS score on admission and on discharge and the MRS score conducted on discharge and 3 months after the onset of their insults. Each patient underwent carotid duplex examination with special comment on carotid intima-media thickness (CAIMT) (the intima-media thickness of the common carotid artery), the nature of the atherosclerotic plaques whether soft or hard and the degree of stenosis if found (significant if more than 50%). Demographic data of patients revealed that the mean age among the study subjects (n=70) is 58.06 ±5.28 years. Males included in the study were (78.6%) and females were (21.4%).