Connection Between Leukoaraiosis and Ischemic Stroke

Leukoaraiosis (LA) is a common finding in stroke (particularly ischemic) and has been strongly associated with risk of incident stroke and dementia. LA shares similar risk factors and pathophysiologic mechanisms with both ischemic and hemorrhagic stroke. LA may also be an independent predictor of stroke outcomes. In general populations, both lacunar strokes and LA are associated with a high risk of recurrent stroke events and cognitive decline. Aft er an acute ischemic stroke LA is associated with an increased risk of death or dependency, recurrent stroke, intracerebral hemorrhage under anticoagulation, myocardial infarction, and poststroke dementia. Th ere is increasing evidence from neuroimaging studies to support the concept that some cases of LA are caused by white matter infarcts, which may be particularly frequent in patients with widespread small vessel disease. Th e relatively similar distribution of LA regardless of the distribution of vascular pathology suggests a conserved vulnerability to white matter injury across various vascular diseases, possibly related to the resting patterns of blood fl ow. More insights into the pathophysiology of leukoaraiosis are needed to reduce the burden of disability associated with this common condition.