Possible Occurrence of Delayed Leukoencephalopathy Following Acute Ischemic Stroke With Large-Vessel Occlusion

BACKGROUND: Typically detected at least 14 days after acute ischemic stroke onset, delayed leukoencephalopathy (DL) involves diffuse hyperintensities restricted to white matter on fluid-attenuated inversion recovery accompanied mostly by partial diffusion weighted image hyperintensities. DL cases, which are rarely reported, have occurred after large-vessel occlusion (LVO). Herein, we aim to elucidate the incidence and factors associated with DL. METHODS: Our study covers consecutive ischemic strokes involving: (1) onset-to-door time within 7 days and (2) available scans from at least a second magnetic resonance imaging procedure at least 14 days after onset. First, we examined the incidence of DL generally and whether LVO could be a risk factor for DL in ischemic strokes generally, and second, we examined the incidence and risk factors associated with DL in patients with LVO. RESULTS: We screened 1857 consecutive patients with ischemic stroke and selected 792 general patients-573 (72%) men, median age 67 years-and 183 patients with LVO-128 (70%) men, median age 67 years. DL was detected in 2.3% of the general patients and 9.2% of the patients with LVO ischemic stroke. LVO was strongly associated with DL (odds ratio [OR], 69.1 [95 CI, 9.06-526]; P<0.001). Among patients with LVO, DL-associated factors were age/10 years (OR, 1.76 [95% CI, 1.13-2.75]; P=0.012), low-density lipoprotein cholesterol/10 mg/dL (OR, 0.863 [95% CI, 0.745-1.00]; P=0.049), complete recanalization (OR, not calculable; P<0.001), and endovascular therapy (OR, 17.4 [95% CI, 4.44-68.5]; P<0.001). CONCLUSION: DL might not be rare following LVO. We speculate that certain risk factors and their combinations are key in the development of DL.