Brain Volume: An Important Determinant of Functional Outcome After Acute Ischemic Stroke

Markus D. Schirmer, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts General Hospital, Boston; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Boston; Department of Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany. Electronic address: mschirmer1@mgh.harvard.edu.
Kathleen L. Donahue, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts General Hospital, Boston.
Marco J. Nardin, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts General Hospital, Boston.
Adrian V. Dalca, Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Boston; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown.
Anne-Katrin Giese, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts General Hospital, Boston.
Mark R. Etherton, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts General Hospital, Boston.
Steven J. Mocking, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown.
Elissa C. McIntosh, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown.
John W. Cole, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD; Veterans Affairs Maryland Health Care System, Baltimore, MD.
Lukas Holmegaard, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Katarina Jood, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Jordi Jimenez-Conde, Department of Neurology, Neurovascular Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona, Barcelona, Spain.
Steven J. Kittner, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD; Veterans Affairs Maryland Health Care System, Baltimore, MD.
Robin Lemmens, Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease, KU Leuven-University of Leuven, Flemish Institute for Biotechnology, Vesalius Research Center, Laboratory of Neurobiology, and Department of Neurology, University Hospitals Leuven, Leuven, Belgium.
James F. Meschia, Department of Neurology, Mayo Clinic, Jacksonville, FL.
Jonathan Rosand, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts General Hospital, Boston; Center for Genomic Medicine, Massachusetts General Hospital, Boston; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown.
Jaume Roquer, Department of Neurology, Neurovascular Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona, Barcelona, Spain.
Tatjana Rundek, Department of Neurology and Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL.
Ralph L. Sacco, Department of Neurology and Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL.
Reinhold Schmidt, Department of Neurology, Clinical Division of Neurogeriatrics, Medical University Graz, Graz, Austria.
Pankaj Sharma, Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham, UK, and St Peter's and Ashford Hospitals Foundation Trust, Chertsey, UK.
Agnieszka Slowik, Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.
Tara M. Stanne, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Achala Vagal, Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH.
Johan Wasselius, Department of Clinical Sciences, Radiology, Lund University, Lund, Sweden; Department of Radiology, Division of Neuroradiology, Skåne University Hospital, Malmö, Sweden.
Daniel Woo, Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH.
Stephen Bevan, School of Life Sciences, University of Lincoln, Lincoln, UK.
Laura Heitsch, Division of Emergency Medicine, Washington University School of Medicine, St Louis, MO.
Chia-Ling Phuah, Department of Neurology, Washington University School of Medicine, St Louis, MO; Barnes-Jewish Hospital, St Louis, MO.
Daniel Strbian, Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.
Turgut Tatlisumak, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.

Document Type

Article

Abstract

OBJECTIVE: To determine whether brain volume is associated with functional outcome after acute ischemic stroke (AIS). PATIENTS AND METHODS: This study was conducted between July 1, 2014, and March 16, 2019. We analyzed cross-sectional data of the multisite, international hospital-based MRI-Genetics Interface Exploration study with clinical brain magnetic resonance imaging obtained on admission for index stroke and functional outcome assessment. Poststroke outcome was determined using the modified Rankin Scale score (0-6; 0 = asymptomatic; 6 = death) recorded between 60 and 190 days after stroke. Demographic characteristics and other clinical variables including acute stroke severity (measured as National Institutes of Health Stroke Scale score), vascular risk factors, and etiologic stroke subtypes (Causative Classification of Stroke system) were recorded during index admission. RESULTS: Utilizing the data from 912 patients with AIS (mean ± SD age, 65.3±14.5 years; male, 532 [58.3%]; history of smoking, 519 [56.9%]; hypertension, 595 [65.2%]) in a generalized linear model, brain volume (per 155.1 cm) was associated with age (β -0.3 [per 14.4 years]), male sex (β 1.0), and prior stroke (β -0.2). In the multivariable outcome model, brain volume was an independent predictor of modified Rankin Scale score (β -0.233), with reduced odds of worse long-term functional outcomes (odds ratio, 0.8; 95% CI, 0.7-0.9) in those with larger brain volumes. CONCLUSION: Larger brain volume quantified on clinical magnetic resonance imaging of patients with AIS at the time of stroke purports a protective mechanism. The role of brain volume as a prognostic, protective biomarker has the potential to forge new areas of research and advance current knowledge of the mechanisms of poststroke recovery.

Medical Subject Headings

Aged; Brain (anatomy & histology, diagnostic imaging); Brain Ischemia (complications, physiopathology); Cross-Sectional Studies; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Organ Size; Recovery of Function; Stroke (etiology, physiopathology)

Publication Date

5-1-2020

Publication Title

Mayo Clinic proceedings

E-ISSN

1942-5546

Volume

95

Issue

5

First Page

955

Last Page

965

PubMed ID

32370856

Digital Object Identifier (DOI)

10.1016/j.mayocp.2020.01.027

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