Enlarged perivascular spaces are associated with worse gait velocity and recovery in individuals with a small ischemic hemisphere stroke: A cross-sectional study

Abstract

Background

Enlarged perivascular spaces (EPVS) are commonly observed in individuals with cerebral small vessel disease (CSVD) and have been associated with gait impairments in older adults and are also linked to post-stroke disability. Among individuals with mild stroke, persistent gait disturbance limitations often pose significant challenges to the resumption of daily activities. The relationship between EPVS and gait disturbance and gait recovery in individuals with mild stroke, remains poorly understood.

Objective

This study aimed to examine the hypothesis that EPVS are associated with gait disturbance and delayed gait recovery in individuals with mild stroke.

Methods

Between May and November 2023, 164 participants with small ischemic hemisphere strokes were enrolled within one week of stroke onset. EPVS were assessed using magnetic resonance imaging (MRI), while gait disturbance was measured by gait velocity, cadence, and stride length, with metrics extracted using the BlazePose architecture. Gait recovery was monitored by tracking the return to independent gait over time. Linear and logistic regression models were used to explore the relationship between EPVS and gait disturbance, while multifactorial Cox regression models were employed to assess the impact of EPVS on gait recovery.

Results

The mean [SD] age of the participants was 66.8 [9.7] years, with 72 % of the cohort being male. In multiple linear regression analyses, the presence of EPVS in the basal ganglia (BG-EPVS) was found to be a significant predictor of reduced gait velocity (β= -0.06; [95 % CI, -0.09 to -0.03]). In the multifactorial Cox regression model, moderate to severe BG-EPVS were significantly associated with delayed recovery of independent gait among participants with stroke, adjusted hazard ratio (aHR) 0.55 [95 % CI, 0.38 to 0.79].

Conclusion

The presence of BG-EPVS was found to be significantly associated with gait disturbance and delayed recovery of independent gait in individuals with mild stroke, indicating the potential role of EPVS as a predictor of gait recovery.