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Severe Leukoaraiosis Portends a Poor Outcome After Traumatic Brain Injury

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Abstract

Background and Purpose

It is now well accepted that traumatic white matter injury constitutes a critical determinant of post-traumatic functional impairment. However, the contribution of preexisting white matter rarefaction on outcome following traumatic brain injury (TBI) is unknown. Hence, we sought to determine whether the burden of preexisting leukoaraiosis of presumed ischemic origin is independently associated with outcome after TBI.

Methods

We retrospectively analyzed consecutive, prospectively enrolled patients of ≥50 years (n = 136) who were admitted to a single neurological/trauma intensive care unit. Supratentorial white matter hypoattenuation on head CT was graded on a 5-point scale (range 0–4) reflecting increasing severity of leukoaraiosis. Outcome was ascertained according to the modified Rankin Scale (mRS) and Glasgow outcome scale (GOS) at 3 and 12 months, respectively.

Results

After adjustment for other factors, leukoaraiosis severity was significantly associated with a poor outcome at 3 and 12 months defined as mRS 3–6 and GOS 1–3, respectively. The independent association between leukoaraiosis and poor outcome remained when the analysis was restricted to patients who survived up to 3 months, had moderate-to-severe TBI [enrollment Glasgow Coma Scale (GCS) ≤12; p = 0.001], or had mild TBI (GCS 13–15; p = 0.002), respectively.

Conclusion

We provide first evidence that preexisting cerebral small vessel disease independently predicts a poor functional outcome after closed head TBI. This association is independent of other established outcome predictors such as age, comorbid state as well as intensive care unit complications and interventions. This knowledge may help improve prognostic accuracy, clinical management, and resource utilization.

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Acknowledgments

We gratefully acknowledge Cynthia Ouillette, RN, University of Massachusetts Medical School, Worcester, MA for her help with data acquisition.

Disclosures

Dr. Muehlschlegel has received research support from the American Heart Association, Worcester Research Foundation, and UMASS Faculty Scholar Award. Dr. Carandang has received research support from the Worcester Research Foundation. All other authors report no disclosures.

Author information

Authors and Affiliations

  1. Department of Neurology, University of Massachusetts Medical School, 55 Lake Ave, North, Worcester, MA, 01655, USA

    Nils Henninger, Saef Izzy, Raphael Carandang, Wiley Hall & Susanne Muehlschlegel

  2. Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Ave, North, Worcester, MA, 01655, USA

    Nils Henninger

  3. Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA

    Raphael Carandang, Wiley Hall & Susanne Muehlschlegel

  4. Department of Anesthesia/Critical Care, University of Massachusetts Medical School, Worcester, MA, 01655, USA

    Susanne Muehlschlegel

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  1. Nils Henninger
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  5. Susanne Muehlschlegel
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Correspondence to Nils Henninger.

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Henninger, N., Izzy, S., Carandang, R. et al. Severe Leukoaraiosis Portends a Poor Outcome After Traumatic Brain Injury. Neurocrit Care 21, 483–495 (2014). https://doi.org/10.1007/s12028-014-9980-0

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  • DOI: https://doi.org/10.1007/s12028-014-9980-0

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