The relation between total cerebral small vessel disease burden and gait impairment in patients with minor stroke

Background and aims – Individual MRI markers of cerebral small vessel disease(cSVD) are associated with gait impairment. The impact of total cSVD-related brain damage, expressed by a cSVD MRI burden score, on mobility after stroke, has not been considered, although this score gives a better representation of the overall effect of cSVD on the brain. We determined if the total cSVD burden is associated with gait impairment three years after minor stroke.Methods – In total, 200 patients with minor lacunar or non-lacunar stroke (NIHSS≤7) underwent a brain MRI at presentation. Presence of lacunes, white matter hyperintensities, cerebral microbleeds and perivascular spaces were summed in a total cSVD MRI burden score (range 0–4). Gait disturbances, measured by timed-upand-go test and self-reported Stroke Impact Scale mobility domain were assessed three years after stroke. We tested associations adjusted for key variables by linear regression analysis.Results – Total cSVD burden was not associated with gait impairment after minorstroke in all patients, nor in lacunar stroke patients (n=87). In non-lacunar stroke patients (n=113) total cSVD burden was associated with lower Stroke Impact Scale mobility domain scores, independent of age, vascular risk factors and stroke severity (unstandardized B -4.61; 95% CI -8.42;-0.79, p<0.05).Conclusion – Patients with non-lacunar stroke and a higher total cSVD burden have more subjective mobility impairment three years after stroke. The total cSVD MRI burden score is a possible marker to identify patients at risk for subjective gait impairment. These findings should be confirmed in larger studies.