Ischemic white matter lesions in young adults: Risk factors, MRI findings and cognitive status

Introduction: Although frequently assumed to be age-related changes, vascular white matter lesions (WML) are sometimes found in young adults. Etiology is usually attributed to sporadic small vessel disease; nevertheless, genetic disorders may also be implicated. We aimed to characterize the population of young adults with vascular WML in Neurology outpatient clinics. Methods: Neurologists from 12 Portuguese hospitals were invited to include patients aged 18–55 years evaluated in consultation, with vascular WML on MRI, scoring II or III in the Fazekas scale. Central imaging validation was performed by 2 independent, blinded, Neuroradiologists. Demographic and clinical data were collected as well as results of investigations performed. Results: During 2 years, 77 patients were included (mean age 47.7 years). Vascular risk factors were present in 88.3% patients (hypertension in 53.2%) and previous history of stroke in 36.4%. Patients without history of stroke were younger (46.6 ± 7.2 vs. 49.6 ± 3.9 years, p = 0.045) and had fewer vascular risk factors (p < 0.001). They were more frequently females (87.8 vs. 46.4%, p < 0.001), and headache (30.6 vs. 3.6%, p = 0.007), contrary to focal symptoms (16.3 vs. 53.6%, p = 0.001), was the most frequent reason of referral. Etiological investigations performed differed between Neurologists. A genetic disorder was identified in 6 out of 58 patients (CADASIL n = 5; COL4A1 n = 1). Conclusion: Young adults with vascular WML evaluated in Neurology outpatient clinics concentrate in the oldest age groups. Vascular risk factors should be screened carefully in this population. Among patients without history of stroke, females largely outweigh males. Diagnostic investigations performed do not follow a standardized protocol.

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Abstract WP248: PFO Shunting is Associated With Increased Long-Term Risk of Dementia

Stroke ◽

10.1161/str.51.suppl_1.wp248 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Wenjun Deng ◽

David McMullin ◽

Ferdinando Buonanno ◽

Eng Lo ◽

MingMing Ning

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

White Matter ◽

Recurrent Events ◽

Prolonged Exposure ◽

White Matter Lesions ◽

Cognitive Status ◽

Atrial Septal Aneurysm ◽

Dementia Patients ◽

Increased Risk

Background: Right-to-left interatrial shunting through a patent foramen ovale (PFO) has been associated with white matter lesions in literature and in our data. Since white matter lesions, particularly those in the periventricular and subcortical regions, increase the risk of cognitive impairment, we investigate the relationship between PFO shunting and dementia. Method: 1078 consecutive PFO stroke patients were prospectively recruited in accordance with IRB protocol. No patient had diagnosis of dementia prior to initial stroke. PFO shunt size was evaluated by echocardiography with saline contrast. Cognitive status and recurrent events were followed for up to 11 years. Result: 27 patients (2.50%) developed vascular cognitive impairment and dementia over 11 years. As expected, dementia patients were older (p<0.001) and were more likely to have hypertension (p<0.001) and hyperlipidemia (p=0.001) (Table 1). Notably, the dementia patients were also more likely to have a large PFO shunt (22.2% vs 8.3%, p=0.023). The association of PFO shunt and dementia remained robust (Odds ratio: 3.07; 95% CI: 1.11~8.55; p=0.031) after adjusting for important traditional risk factors (age, hypertension, hyperlipidemia, diabetes). But PFO risk factors (hypermobile septum, atrial septal aneurysm) that enhance PFO shunting remain significant (Table 2). Conclusion: Our study provides support for the hypothesis that the presence of large PFO right-to-left shunting is associated with increased risk of later dementia. We previously reported that PFO shunting enables vasoactive factors to stay elevated in circulation and to contribute to cerebrovascular dysfunction. We hypothesize here that prolonged exposure to PFO shunting may lead to cognitive decline. Further studies assessing PFO shunt size, dementia severity, and other confounders in a non-stroke PFO cohort are ongoing to validate these findings.

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Vascular lesions and functional limitations among older adults: does depression make a difference?

International Psychogeriatrics ◽

10.1017/s1041610214000829 ◽

2014 ◽

Vol 26 (9) ◽

pp. 1501-1509 ◽

Cited By ~ 5

Author(s):

Celia F. Hybels ◽

Carl F. Pieper ◽

Lawrence R. Landerman ◽

Martha E. Payne ◽

David C. Steffens

Keyword(s):

Risk Factors ◽

Older Adults ◽

White Matter ◽

Functional Impairment ◽

Functional Limitations ◽

Late Life ◽

Cognitive Status ◽

Cerebral White Matter ◽

Late Life Depression ◽

Increased Risk

ABSTRACTBackground:The association between disability and depression is complex, with disability well established as a correlate and consequence of late life depression. Studies in community samples report that greater volumes of cerebral white matter hyperintensities (WMHs) seen on brain imaging are linked with functional impairment. These vascular changes are also associated with late life depression, but it is not known if depression is a modifier in the relationship between cerebrovascular changes and functional impairment.Methods:The study sample was 237 older adults diagnosed with major depression and 140 never depressed comparison adults, with both groups assessed at study enrollment. The dependent variable was the number of limitations in basic activities of daily living (ADL), instrumental ADLs, and mobility tasks. The independent variable was the total volume of cerebral white matter lesions or hyperintensities assessed though magnetic resonance imaging.Results:In analyses controlling for age, sex, race, high blood pressure, and cognitive status, a greater volume of WMH was positively associated with the total number of functional limitations as well as the number of mobility limitations among those older adults with late life depression but not among those never depressed, suggesting the association between WMH volume and functional status differs in the presence of late life depression.Conclusions:These findings suggest older patients with both depression and vascular risk factors may be at an increased risk for functional decline, and may benefit from management of both cerebrovascular risk factors and depression.

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The Prevalence and Severity of White Matter Lesions, Their Relationship with Age, Ethnicity, Gender, and Cardiovascular Disease Risk Factors: The ARIC Study

Neuroepidemiology ◽

10.1159/000368814 ◽

1997 ◽

Vol 16 (3) ◽

pp. 149-162 ◽

Cited By ~ 258

Author(s):

Duanping Liao ◽

Lawton Cooper ◽

Jianwen Cai ◽

James Toole ◽

Nick Bryan ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

White Matter ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

White Matter Lesions ◽

Cardiovascular Disease Risk Factors ◽

Aric Study

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Cognitive features of white matter lesions accompanied by different risk factors of cerebrovascular diseases

Advances in Clinical and Experimental Medicine ◽

10.17219/acem/110324 ◽

2019 ◽

Vol 28 (12) ◽

pp. 1705-1710

Author(s):

Yafei Shangguan ◽

Tao Xiong ◽

Changwei Jiang ◽

Wei Chen ◽

Yan Zhang ◽

...

Keyword(s):

Risk Factors ◽

White Matter ◽

White Matter Lesions ◽

Cerebrovascular Diseases

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The study on analysis of risk factors for severity of white matter lesions and its correlation with cerebral microbleeds in the elderly with lacunar infarction

Medicine ◽

10.1097/md.0000000000018865 ◽

2020 ◽

Vol 99 (4) ◽

pp. e18865

Author(s):

Yu-Ni Zhou ◽

Hao-Yuan Gao ◽

Fang-Fang Zhao ◽

Ying-Chun Liang ◽

Yuan Gao ◽

...

Keyword(s):

Risk Factors ◽

White Matter ◽

White Matter Lesions ◽

The Elderly ◽

Cerebral Microbleeds ◽

Lacunar Infarction

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Full Recovery From Cocaine-Induced Toxic Leukoencephalopathy: Emphasizing the Role of Neuroinflammation and Brain Edema

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709619868266 ◽

2019 ◽

Vol 7 ◽

pp. 232470961986826 ◽

Cited By ~ 1

Author(s):

Edward C. Mader ◽

Alexander B. Ramos ◽

Roberto A. Cruz ◽

Lionel A. Branch

Keyword(s):

White Matter ◽

Time Course ◽

Brain Mri ◽

White Matter Lesions ◽

Psychomotor Retardation ◽

Full Recovery ◽

White Matter Disease ◽

Mri Findings ◽

Prognostic Information ◽

Toxic Leukoencephalopathy

Toxic leukoencephalopathy (TL) is characterized by white matter disease on magnetic resonance imaging (MRI) and evidence of exposure to a neurotoxic agent. We describe a case of cocaine-induced TL in which extensive white matter disease did not preclude full recovery. A 57-year-old man with substance abuse disorder presented with a 5-day history of strange behavior. On admission, he was alert but had difficulty concentrating, psychomotor retardation, and diffuse hyperreflexia. Brain MRI revealed confluent subcortical white matter hyperintensities with restricted diffusion in some but not in other areas. Electroencephalography (EEG) showed mild diffuse slowing. Blood tests were normal except for mild hyperammonemia. Urine screen was positive for cocaine and benzodiazepine but quantitative analysis was significant only for cocaine. Prednisone 60-mg qd was initiated on day 4, tapered over a 5-day period, and discontinued on day 9. He was discharged after 3 weeks. Cognitive function returned to normal 2 weeks after discharge. Five months later, neurologic exam and EEG were normal and MRI showed near-100% resolution of white matter lesions. TL has been attributed to white matter ischemia/hypoxia resulting in demyelination/axonal injury. The clinical, EEG, and MRI findings and time course of recovery of our patient suggest that cocaine-induced inflammation/edema resulted in TL but not in ischemic/hypoxic injury. While inflammation/edema may have regressed when cocaine was discontinued, we cannot exclude a role for prednisone in protecting the patient from the ischemic/hypoxic sequelae of inflammation/edema. MRI is indispensable for diagnosing TL but EEG may provide additional useful diagnostic and prognostic information.

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