An observational study of T2-weighted white matter hyperintensities on magnetic resonance imaging of the internal auditory meatus and brain: ignore or not?

Abstract Background Magnetic resonance imaging of the internal auditory meatus frequently detects incidental white matter hyperintensities. This study investigated the association between these and the risk of stroke and transient ischaemic attack, or myocardial infarction. Methods The records of patients with incidental white matter hyperintensities were reviewed, and data were collected on: age, sex, cardiovascular risk factors, and incidence of stroke and transient ischaemic attack, or myocardial infarction, five years later. The risk factors associated with vascular events were explored. Results Of 6978 patients, 309 (4.4 per cent) had incidental white matter hyperintensities. Of these, 20 (6.5 per cent) had a stroke or transient ischaemic attack within five years, and 5 (1.7 per cent) had a myocardial infarction. The number of cardiovascular risk factors was significantly associated with the incidence of stroke and transient ischaemic attack (p = 0.004), and myocardial infarction (p = 0.023). Conclusion The number of cardiovascular risk factors predicts the likelihood of vascular events; appropriate risk factor management is recommended for patients with incidental white matter hyperintensities of presumed vascular origin.

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Rehabilitation of patients after transient ischaemic attack or minor stroke: pilot feasibility randomised trial of a home-based prevention programme

British Journal of General Practice ◽

10.3399/bjgp19x705509 ◽

2019 ◽

Vol 69 (687) ◽

pp. e706-e714 ◽

Cited By ~ 3

Author(s):

Neil Heron ◽

Frank Kee ◽

Jonathan Mant ◽

Margaret E Cupples ◽

Michael Donnelly

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Secondary Prevention ◽

Cardiovascular Risk Factors ◽

Transient Ischaemic Attack ◽

Standard Care ◽

Minor Stroke ◽

Home Based ◽

Ischaemic Attack

BackgroundAlthough the importance of secondary prevention after transient ischaemic attack (TIA) or minor stroke is recognised, research is sparse regarding novel, effective ways in which to intervene in a primary care context.AimTo pilot a randomised controlled trial (RCT) of a novel home-based prevention programme (The Healthy Brain Rehabilitation Manual) for patients with TIA or ‘minor’ stroke.Design and settingPilot RCT, home-based, undertaken in Northern Ireland between May 2017 and March 2018.MethodPatients within 4 weeks of a first TIA or ‘minor’ stroke received study information from clinicians in four hospitals. Participants were randomly allocated to one of three groups: standard care (control group) (n = 12); standard care with manual and GP follow-up (n = 14); or standard care with manual and stroke nurse follow-up (n = 14). Patients in all groups received telephone follow-up at 1, 4, and 9 weeks. Eligibility, recruitment, and retention were assessed; stroke/cardiovascular risk factors measured at baseline and 12 weeks; and participants’ views were elicited about the study via focus groups.ResultsOver a 32-week period, 28.2% of clinic attendees (125/443) were eligible; 35.2% of whom (44/125) consented to research contact; 90.9% of these patients (40/44) participated, of whom 97.5% (39/40) completed the study. After 12 weeks, stroke risk factors [cardiovascular risk factors, including blood pressure and measures of physical activity] improved in both intervention groups. The research methods and the programme were acceptable to patients and health professionals, who commented that the programme ‘filled a gap’ in current post-TIA management.ConclusionFindings indicate that implementation of this novel cardiac rehabilitation programme, and of a trial to evaluate its effectiveness, is feasible, with potential for clinically important benefits and improved secondary prevention after TIA or ‘minor’ stroke.

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Brain white-matter hyperintensities and treatment outcome in major depressive disorder

The British Journal of Psychiatry ◽

10.1192/bjp.188.2.180 ◽

2006 ◽

Vol 188 (2) ◽

pp. 180-185 ◽

Cited By ~ 39

Author(s):

Dan V. Iosifescu ◽

Perry F. Renshaw ◽

In Kyoon Lyoo ◽

Ho Kyu Lee ◽

Roy H. Perlis ◽

...

Keyword(s):

Risk Factors ◽

Major Depressive Disorder ◽

Treatment Outcome ◽

Cardiovascular Risk ◽

White Matter ◽

Depressive Disorder ◽

Cardiovascular Risk Factors ◽

White Matter Hyperintensities ◽

Major Depressive ◽

Brain White Matter

BackgroundAn increased incidence of brain white-matter hyperintensities has been described in major depressive disorder, but the impact of such hyperintensities on treatment outcome is still controversial.AimsTo investigate the relationship of brain white-matter hyperintensities with cardiovascular risk factors and with treatment outcome in younger people with major depressive disorder.MethodWe assessed brain white-matter hyperintensities and cardiovascular risk factors in 84 people with major depressive disorder prior to initiating antidepressanttreatment. We also assessed hyperintensities in 35 matched controls.ResultsWe found no significant difference in the prevalence of white-matter hyperintensities between the depression and the control groups. Left-hemisphere subcortical hyperintensities correlated with lower rates of treatment response. We found no correlation between global hyperintensity measures and clinical outcome. Brain white-matter hyperintensities correlated with hypertension and age and with total cardiovascular risk score.ConclusionsSubcortical white-matter hyperintensities in the left hemisphere (but not in other brain areas) may be associated with poor response to antidepressant treatment in major depression.

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