Lihao Zhang,1 Yan Su,2 Qian Wang,1 Yan Wang,1 Yikun Guo1 

1Department of Neurology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, People’s Republic of China; 2Department of Radiology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, People’s Republic of China

Correspondence: Yikun Guo, Department of Neurology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, 68# Middle Gehu Road, Changzhou, Jiangsu Province, 213000, People’s Republic of China, Tel +86-519-81087079, Fax +86-519-81087711, Email guoyikun000@163.com

Objective: To explore the role of white matter hyperintensities (WMH) in predicting early neurological deterioration (END) in patients with embolic stroke of undetermined source (ESUS) without reperfusion therapy.
Methods: In a retrospective analysis, 111 acute ESUS patients not treated with reperfusion therapy were enrolled. WMH severity was evaluated using the Fazekas scale, with patients categorized into mild (Fazekas score ≤ 2) or moderate-to-severe (Fazekas score ≥ 3) WMH groups. Clinical data were compared between the groups, and END was monitored within 72 hours of hospital admission. The association between WMH and END was assessed using binary logistic regression.
Results: Patients with moderate-to-severe WMH were significantly older (p = 0.001) and more likely to have a history of stroke (28.6% vs 10.5%, p = 0.017) compared to the mild WMH group. The END group (n=16) presented with higher baseline NIHSS scores and a greater prevalence of moderate-to-severe WMH (p < 0.05). Binary logistic regression identified moderate-to-severe WMH (OR = 4.012, 95% CI: 1.080– 14.906, p = 0.038), smoking (OR = 4.368, 95% CI: 1.171– 16.293, p = 0.028), and diabetes mellitus (OR = 3.986, 95% CI: 1.007– 15.789, p = 0.049) as independent predictors of END in ESUS patients.
Conclusion: Moderate-to-severe WMH is an independent risk factor for END in ESUS patients not receiving reperfusion therapy, highlighting the importance of considering WMH in the clinical evaluation and management of stroke patients.

Keywords: white matter hyperintensities, early neurological deterioration, embolic stroke of undetermined source, risk factors