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• W3205185752 abstract "Objective: To investigate the effect of microstructural integrity of normal appearing white matter (NAWM) on early neurologic improvement (ENI) after acute ischemic stroke. Background: White matter hyperintensity (WMH) burden and NAWM microstructural integrity influence long-term outcomes after ischemic stroke. Design/Methods: In a prospective observational study of patients with moderate to severe white matter hyperintensity (WMH) burden, 42 AIS patients had brain MRIs with dynamic susceptibility contrast perfusion and diffusion tensor imaging performed within 12 hours and at 3–5 days after stroke onset. Clinical variables were obtained on admission. ENI was defined as an improvement in the NIHSS of ≥2 points from admission to day 3–5. Acute infarct volume (DWIv) and acute Tmax volume were determined to calculate the mismatch ratio (Tmax/DWIv). Final infarct volume (FIV) was extracted from follow-up FLAIR sequences. Median diffusivity metrics and blood brain barrier leakage rates (K2 coefficient) were measured in contralesional NAWM. Wilcoxon rank sum and Chi-square test were used for statistical analysis. A backward elimination, stepwise logistic regression was conducted on radiographic predictors of ENI. Results: 52.3% of our population met criteria for ENI. There was no difference in age, sex, pre-stroke disability, administration of intravenous tPA, WMH volume, acute Tmax volume, or FIV between those patients with (ENI+) and without (ENI−) ENI. The ENI+ group had a higher admission NIHSS (median, 95%CI: ENI+ 10.5, 7.3–13.8; ENI− 3.5, 2.0–7.3; p=0.0006) and decreased incidence of diabetes (4.5% vs. 40%; p=0.008), hypertension (54.5% vs. 85.0%; p=0.048), and hyperlipidemia (36.4% vs. 75.0%; p=0.016). Radial diffusivity in NAWM was significantly lower in the ENI+ group (0.624 vs. 0.658; p = 0.03). In the backward elimination, logistic regression model, NAWM axial diffusivity (β = −10.6, p-value 0.039) and fractional anisotropy (β = 20.2, p-value 0.047) were independent predictors of ENI. Conclusions: Decreased NAWM microstructural integrity is associated with lack of ENI after AIS. Study Supported by: This study was supported in part by NIH-NINDS K23NS064052, R01NS082285, P50NS051343 and R01NS086905; NIBIB (P41EB015896); AHA 17CPOST33680102, AHA/Bugher Foundation Centers for Stroke Prevention Research (0775010N). Disclosure: Dr. Etherton has nothing to disclose. Dr. Wu has nothing to disclose. Dr Giese has nothing to disclose. Dr. Lauer has nothing to disclose. Dr. Boulouis has nothing to disclose. Dr. Mills has nothing to disclose. Dr. Cloonan has nothing to disclose. Dr. Donahue has nothing to disclose. Dr. Copen has nothing to disclose. Dr. Schaefer has nothing to disclose. Dr. Rost has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Broadview Ventures (Consulting), Covance Inc (Clinical Events Committee), Merck and Co. (Clinical Events Committee), Omniox (Scientific Advisory Board), Sanofi Genzyme (Scientific Advisory Board)." @default.
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• W3205185752 date "2018-04-10" @default.
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• W3205185752 title "White Matter Integrity is Associated with Early Neurologic Improvement After Ischemic Stroke (S40.002)" @default.
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