Characteristics of the clinical course of ischemic stroke against the background small vessel disease

Abstract

Objective  — to study the clinical course and functional recovery of patients with various pathogenetic subtypes of ischemic stroke (IS) in small vessel disease (SVD). Methods and subjects. We performed a cohort prospective study of 117 patients with acute IS in SVD. 48 men and 69 women (mean age 67.7 ± 8.2 years) were included into study. Patients were divided into three groups based on the pathogenetic subtype of IS: atherothrombotic (AT, n = 66), cardioembolic (CE, n = 24) and lacunar (LI, n = 27). Inclusion criteria were: the first IS, history of arterial hypertension (AH), signs of SVD according to MRI. All patients underwent a comprehensive clinical, neurological, laboratory and instrumental examination. The diagnosis and the subtype of IS were verified by Doppler ultrasonography of head and neck vessels, Echo CG, ECG, and cerebral MRI. The degree of impairment of neurological functions was assessed on the 1st, 7th and 14th days after the hospitalization by NIHSS. On the 14th day, the level of daily life activity was assessed using the Bartel index (BI), and the degree of disability was estimated using the modified Rankine scale (mRS). Results. There was a difference in the signs of SVD in various pathogenetic subtypes of IS: significantly more white matter hyperintensity was found in patients with the AT subtype, whereas with the CE subtype, lacunae were observed more often (p < 0.01). It was revealed that SVD has more impact in AT and LI subtypes of IS. SVD has been shown to have different interdependence between stroke severity and functional recovery in various IS subtypes: the white matter hyperintensity and expansion of perivascular spaces on MRI relate to bigger stroke severity and worse functional recovery in AT subtype, whereas microhemorrhages and lacunas have greater effect in LI. Severity of stroke and functional status of CE subtype of IS do not corelate to SVD. Conclusions. In the presence of AH, signs of SVD can be detected in all pathogenetic subtypes of IS, regardless of the presence of other risk factors. Related to SVD pronounced neuroimaging changes develop at the 2nd stage of AH. Different neuroimaging signs of SVD are recorded with different frequency in AT, CE and LI subtypes of IS. Their presence mostly affects the course of AT and LI subtypes of IS. There is a relationship between the severity of stroke, functional recovery of patients with AT and LI subtypes of IS and neuroimaging signs of SVD, but its role in the development of IS and the recovery of patients with different subtypes of IS requires further study.