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However, few studies have focused on less common locations, such as brainstem white matter hyperintensities (B\u2010<jats:styled-content style=\"fixed-case\">WMH<\/jats:styled-content>), and their relationship to S\u2010<jats:styled-content style=\"fixed-case\">WMHV<\/jats:styled-content>. This study aimed to examine whether B\u2010<jats:styled-content style=\"fixed-case\">WMH<\/jats:styled-content> affect clinical outcome after <jats:styled-content style=\"fixed-case\">AIS<\/jats:styled-content> or transient ischemic attack (<jats:styled-content style=\"fixed-case\">TIA<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Based on magnetic resonance imaging evidence, B\u2010<jats:styled-content style=\"fixed-case\">WMH<\/jats:styled-content> were evaluated in 313 prospectively identified patients with <jats:styled-content style=\"fixed-case\">AIS<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">TIA<\/jats:styled-content> and registered as absent or present. Standardized S\u2010<jats:styled-content style=\"fixed-case\">WMHV<\/jats:styled-content> was quantified using a validated volumetric image analysis and natural log\u2010transformed (Log_S\u2010<jats:styled-content style=\"fixed-case\">WMHV<\/jats:styled-content>). Poor outcome was defined as a modified Rankin Scale score of 3\u20136 at 3 months after the index event.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Brainstem white matter hyperintensities were detected in 57 (18.2%) patients. In unadjusted analyses for outcome, the presence of B\u2010<jats:styled-content style=\"fixed-case\">WMH<\/jats:styled-content> was associated with worse outcome, compared with patients without B\u2010<jats:styled-content style=\"fixed-case\">WMH<\/jats:styled-content> (<jats:italic>P<\/jats:italic> = 0.034). In multivariate analysis controlling for age, atrial fibrillation, stroke severity, reperfusion therapies and Log_S\u2010<jats:styled-content style=\"fixed-case\">WMHV<\/jats:styled-content>, only B\u2010<jats:styled-content style=\"fixed-case\">WMH<\/jats:styled-content> [odds ratio (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>), 2.46; <jats:italic>P<\/jats:italic> = 0.021] and stroke severity (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>, 1.23; <jats:italic>P<\/jats:italic> &lt; 0.001) remained independently associated with unfavourable 90\u2010day modified Rankin Scale score. Patients with B\u2010<jats:styled-content style=\"fixed-case\">WMH<\/jats:styled-content> were older (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>, 1.06; <jats:italic>P<\/jats:italic> &lt; 0.001) and tended to have more hyperlipidaemia (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>, 2.21; <jats:italic>P<\/jats:italic> = 0.023) and peripheral arterial disease (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>, 2.57; <jats:italic>P<\/jats:italic> = 0.031).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Brainstem white matter hyperintensities are an independent predictor of poor outcome after <jats:styled-content style=\"fixed-case\">AIS<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">TIA<\/jats:styled-content> and this relationship persists after adjustment for important prognostic factors. Our results also show that leukoaraiosis in this location identifies patients with a specific risk factor profile, suggesting differences in the underlying pathogenesis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.13659","type":"journal-article","created":{"date-parts":[[2018,4,16]],"date-time":"2018-04-16T16:16:17Z","timestamp":1523895377000},"page":"1086-1092","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Brainstem leukoaraiosis independently predicts poor outcome after ischemic stroke"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7463-0983","authenticated-orcid":false,"given":"E.","family":"Giralt\u2010Steinhauer","sequence":"first","affiliation":[{"name":"Department of Neurology Hospital del Mar Barcelona"},{"name":"Neurovascular Research Group Institut Hospital del Mar d'Investigacions M\u00e8diques (IMIM) Barcelona"},{"name":"Universitat Aut\u00f2noma de 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