Association of right-to-left shunt with frontal white matter lesions in T2-weighted MR imaging of stroke patients

Background and Purpose.White matter changes (WMCs), or leukoaraiosis (LA), are associated with increased age, hypertension, diabetes mellitus, and history of stroke. Although several lines of evidence suggest a role of atherosclerosis in atherothrombotic vascular events, their involvement in LA remains to be determined. Our study examines this association in ischemic stroke patients.Methods.One hundred and seventy consecutive ischemic stroke or transient ischemic attack (TIA) patients were included. All patients underwent brain computed tomography (CT) with assessment of the extension and severity of WMCs, carotid arteries duplex scan with measurements of intima-media thickness (IMT) and plaques.Results.Seventy-two patients (42.4%) were found to have white matter lesions, of whom 28.8% had advanced LA. Mean IMT was significantly higher in patients with LA and with advanced LA (P=0.002,P=0.003, resp.). In addition, LA and LA severity were associated with existence of carotid plaque (P=0.007,P=0.004, resp.). In multivariate logistic regression analysis, including all vascular risk factors, LA was found to be associated with age and IMT.Conclusion.This study reinforces the tight association between LA and carotid atherosclerosis in ischemic stroke patients. We conclude that a chronic atherosclerotic disease underlies the pathophysiology of leukoaraiosis and its progression.

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Urinary albumin-to-creatinine ratio is associated with white matter lesions severity in first-ever stroke patients

Journal of the Neurological Sciences ◽

10.1016/j.jns.2017.01.011 ◽

2017 ◽

Vol 373 ◽

pp. 258-262 ◽

Cited By ~ 2

Author(s):

Satoshi Suda ◽

Takuya Kanamaru ◽

Seiji Okubo ◽

Junya Aoki ◽

Takashi Shimoyama ◽

...

Keyword(s):

White Matter ◽

White Matter Lesions ◽

Urinary Albumin ◽

Creatinine Ratio ◽

Stroke Patients

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Diffusion Tensor Imaging Reveals Supplementary Lesions to Frontal White Matter in Idiopathic Normal Pressure Hydrocephalus

Neurosurgery ◽

10.1227/neu.0b013e31820f3401 ◽

2011 ◽

Vol 68 (6) ◽

pp. 1586-1593 ◽

Cited By ~ 22

Author(s):

Niklas Lenfeldt ◽

Anne Larsson ◽

Lars Nyberg ◽

Richard Birgander ◽

Anders Eklund ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

White Matter ◽

Corpus Callosum ◽

Normal Pressure Hydrocephalus ◽

Diffusion Tensor ◽

White Matter Lesions ◽

Normal Pressure ◽

Centrum Semiovale ◽

Frontal White Matter ◽

Before And After

Abstract BACKGROUND: Idiopathic normal-pressure hydrocephalus (INPH) is associated with white matter lesions, but the extent and severity of the lesions do not cohere with symptoms or improvement after shunting, implying the presence of further, yet undisclosed, injuries to white matter in INPH. OBJECTIVE: To apply diffusion tensor imaging (DTI) to explore white matter lesions in patients with INPH before and after drainage of cerebrospinal fluid (CSF). METHODS: Eighteen patients and 10 controls were included. DTI was performed in a 1.5T MRI scanner before and after 3-day drainage of 400 mL of CSF. Regions of interest included corpus callosum, capsula interna, frontal and lateral periventricular white matter, and centrum semiovale. White matter integrity was quantified by assessing fractional anisotropies (FA) and apparent diffusion coefficients (ADC), comparing them between patients and controls and between patients before and after drainage. The significance level corresponded to .05 (Bonferroni corrected). RESULTS: Decreased FA in patients was found in 3 regions (P < .002, P < .001, and P < .001) in anterior frontal white matter, whereas elevated ADC was found in genu corpus callosum (P < .001) and areas of centrum semiovale associated with the precentral gyri (P < .002). Diffusion patterns in these areas did not change after drainage. CONCLUSION: DTI reveals subtle injuries—interpreted as axonal loss and gliosis—to anterior frontal white matter where high-order motor systems between frontal cortex and basal ganglia travel, further supporting the notion that motor symptoms in INPH are caused by a chronic ischemia to the neuronal systems involved in the planning processes of movements.

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