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A relationship between the integrated assessment of magnetic resonance imaging markers for cerebral small vessel disease and the clinical and functional status in the acute period of ischemic stroke

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Cerebral small vessel disease (CSVD) is the most common neurological pathological process and contributes to the process of aging and to the development of dementia and stroke. At the same time, the role of CSVD as a factor influencing the course of acute ischemic stroke (IS) has been little studied. There is no generally accepted magnetic resonance imaging (MRI) scale for the integrated assessment of CSVD markers.

Objective: to carry out an integrated assessment of the MRI manifestations of CSVD in acute ischemic stroke and to analyze a correlation of both individual markers and the final indicator with the clinical and functional status of patients.

Patients and methods. 100 patients with acute IS were examined. All patients underwent standard clinical, laboratory and instrumental examinations, as well as brain MRI estimating the number of lacunae, visible perivascular spaces (PVSs) and leukoaraiosis. The number of cerebral microbleeds (CMBs) was additionally calculated in 57 patients. Integral scale scores were calculated by gradation and summation of four MRI markers of CSVD.

Results. The patients with acute IS showed the high representativeness of individual markers for CSVD. The values of MRI markers for CSVD correlated with age, education level, and cardiovascular parameters in patients. An integrated CSVD severity assessment scale was developed. The overall manifestations of CSVD, which were assessed using this scale, were associated with the severity of a stenotic process in the brachycephalic arteries, with BP levels at admission, ejection fraction, hyperglycemia, and atherogenic index of blood lipids. The high CSVD score was also correlated with low mobility and more severe disability in patients being discharged from hospital. The high severity of CSVD was associated with lower neurological deficit regression during inpatient treatment. Subgroup analysis showed the greatest negative impact of CSVD on the severity of stroke in female patients, young and middle-aged ones, diabetics, as well as in patients with noncardioembolic stroke, a smallsized focus, and intima-media thickening.

Conclusion. The overall manifestations of CSVD calculated using the original scale based on the analysis of the degree of lacunae, PVSs, leukoaraiosis, and CMBs are associated with premorbid cardiovascular parameters in a patient and are important indicators for the neurological, cognitive, and functional outcomes of acute IS.

About the Authors

A. A. Kulesh
Academician E.A. Vagner Perm State Medical University, Ministry of Health of Russia; City Clinical Hospital Four
Russian Federation

26, Petropavlovskaya St., Perm 614990;

2, Kim St., Perm 614107

N. A. Kaileva
City Clinical Hospital Four
Russian Federation
2, Kim St., Perm 614107

N. Kh. Gorst
Academician E.A. Vagner Perm State Medical University, Ministry of Health of Russia
Russian Federation
26, Petropavlovskaya St., Perm 614990

V. V. Shestakov
Academician E.A. Vagner Perm State Medical University, Ministry of Health of Russia
Russian Federation
26, Petropavlovskaya St., Perm 614990


1. Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010 Jul;9(7): 689-701. doi: 10.1016/S1474-4422(10)70104-6.

2. Wardlaw JM, Smith C, Dichgans M. Mechanisms of sporadic cerebral small vessel disease: insights from neuroimaging. Lancet Neurol. 2013 May;12(5):483-97. doi: 10.1016/S1474-4422(13)70060-7.

3. The LADIS Study Group, Poggesi A, Pantoni L, Inzitari D, et al. 2001-2011: A Decade of the LADIS (Leukoaraiosis And DISability) Study: What Have We Learned about White Matter Changes and Small-Vessel Disease? Cerebrovasc Dis. 2011;32(6):577-588. Epub 2011 Dec 1.

4. Staals J, Makin SD, Doubal FN, et al. Stroke subtype, vascular risk factors, and total MRI brain small-vessel disease burden. Neurology. 2014 Sep 30;83(14):1228-34. doi: 10.1212/WNL. 0000000000000837. Epub 2014 Aug 27.

5. Wardlaw JM, Smith EE, Biessels GJ, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol. 2013 Aug; 12(8):822-38. doi: 10.1016/S14744422(13) 70124-8.

6. Hassan A, Hunt BJ, O'Sullivan M. Markers of endothelial dysfunction in lacunar infarction and ischaemic leukoaraiosis. Brain. 2003 Feb;126(Pt 2):424-32.

7. MacLullich AM, Wardlaw JM, Ferguson KJ, et al. Enlarged perivascular spaces are associated with cognitive function in healthy elderly men. J Neurol Neurosurg Psychiatry. 2004 Nov;75(11): 1519-23.

8. Kim BJ, Lee SH. Cerebral microbleeds: their associated factors, radiologic findings, and clinical implications. J Stroke. 2013 Sep;15(3): 153-63. doi: 10.5853/jos.2013.15.3.153. Epub 2013 Sep 27.

9. Caunca MR, Del Brutto V, Gardener H, et al. Cerebral Microbleeds, Vascular Risk Factors, and Magnetic Resonance Imaging Markers: The Northern Manhattan Study. J Am Heart Assoc. 2016 Sep 16;5(9). pii: e003477. doi: 10.1161/JAHA.116.003477.

10. Wilson D, Charidimou A, Ambler G, et al. Recurrent stroke risk and cerebral microbleed burden in ischemic stroke and TIA: A metaanalysis. Neurology. 2016 Oct 4;87(14): 1501-1510. Epub 2016 Sep 2.

11. Ihara M, Yamamoto Y. Emerging Evidence for Pathogenesis of Sporadic Cerebral Small Vessel Disease. Stroke. 2016 Feb;47(2):554-60. doi: 10.1161/STROKEAHA.115.009627. Epub 2016 Jan 7.

12. Wardlaw JM, Doubal FN, Eadie E, et al. Little association between intracranial arterial stenosis and lacunar stroke. Cerebrovasc Dis. 2011;31(1):12-8. doi: 10.1159/000319773. Epub 2010 Oct 28.

13. Brundel M, Kappelle LJ, Biessels GJ. Brain imaging in type 2 diabetes. Eur Neuropsychopharmacol. 2014 Dec;24(12):1967-81. doi: 10.1016/j.euroneuro.2014.01.023. Epub 2014 Mar 15.

14. Selim M, Diener HC. Atrial Fibrillation and Microbleeds. Stroke. 2017 Oct;48(10):2660-2664. doi: 10.1161/STROKEAHA.117.017085. Epub 2017 Sep 15.

15. Kim BJ, Lee SH. Prognostic Impact of Cerebral Small Vessel Disease on Stroke Outcome. J Stroke. 2015 May;17(2):101-10. doi: 10.5853/jos.2015.17.2.101. Epub 2015 May 29.

16. Charidimou A, Werring DJ. Cerebral microbleeds and cognition in cerebrovascular disease: an update. J Neurol Sci. 2012 Nov 15; 322(1-2):50-5. doi: 10.1016/j.jns.2012.05.052. Epub 2012 Jun 18.

17. Kato H, Izumiyama M, Izumiyama K, et al. Silent cerebral microbleeds on T2*-weighted MRI: correlation with stroke subtype, stroke recurrence, and leukoaraiosis. Stroke. 2002 Jun; 33(6):1536-40.

18. Sloten TT, Protogerou AD, Henry RM, et al. Association between arterial stiffness, cerebral small vessel disease and cognitive impairment: A systematic review and meta-analysis. Neurosci Biobehav Rev. 2015 Jun;53:121-30. doi: 10.1016/j.neubiorev.2015.03.011. Epub 2015 Mar 28.

19. Ten Dam VH, van den Heuvel DM, van Buchem MA, et al. Effect of pravastatin on cerebral infarcts and white matter lesions. Neurology. 2005 May 24;64(10):1807-9.

20. The SPS3 Investigators, Benavente OR, Hart RG, McClure LA, et al. Effects of clopidogrel added to aspirin in patients with recent lacunar stroke. N Engl J Med. 2012 Aug 30; 367(9):817-25. doi: 10.1056/NEJMoa1204133.

For citation:

Kulesh A.A., Kaileva N.A., Gorst N.K., Shestakov V.V. A relationship between the integrated assessment of magnetic resonance imaging markers for cerebral small vessel disease and the clinical and functional status in the acute period of ischemic stroke. Neurology, Neuropsychiatry, Psychosomatics. 2018;10(1):24-31.

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