Impact Of White Matter Hyperintensities, Cerebral Microbleeds And Medial Temporal Lobe Atrophy On Short And Long-term Rehabilitation Outcomes After Stroke

Abstract

Background and Aims: The impact of MRI biomarkers of small vessel disease burden, i.e. white matter hyperintensities (WMH) and cerebral microbleeds (CMB), and medical temporal lobe atrophy (MTLA) on the short and long-term rehabilitation outcome after stroke remains unclear. Method: We analysed the clinical data for 377 consecutive stroke patients between 2008–2014. 3-tesla MR images were obtained at 7–10 days post-stroke, and examined for the severity of WMH (Fazekas score), CMB (total count), and MTLA (Scheltens score). We assessed the shortterm improvement in function outcomes between admission and discharge for Berg Balance Score, Rivermead Mobility Score, Barthel Index and Functional Independence Measure. Long-term primary outcome was death or vascular events at 2-years, and secondary outcomes included death from any cause, ischaemic stroke/TIA, bleeding events, post-stroke dementia, and admission for pneumonia or falls. Results: Mean s.d. age was 70 12 years; 94% were ischaemic strokes and the overall stroke severity was mild to moderate. Overall prevalence of periventricular WMH was 13%, subcortical WMH was 48%, CMB, was 11%, and MTLA was 36%. WMH, CMB and MTLA independently predicted short-term improvements in balance, mobility, functional and independence levels between admission and discharge. Periventricular WMH, CMB and MTLA also predicted long-term clinical outcomes at 2 years. However, after adjusting for case mix, only MTLA independently predicted pneumonia [OR 0.17 (0.05–0.56)], and periventricular WMH independently predicted falls [OR 5.0 (1.5–16.88)] at 2 years. Conclusion: White matter hyperintensities, cerebral microbleeds and medical temporal lobe atrophy are prevalent amongst stroke rehabilitation patients, and independently predict short and long-term rehabilitation outcomes after stroke.