scholarly journals Cardiovascular risk factors and small vessel disease of the brain: Blood pressure, white matter lesions, and functional decline in older persons

2015 ◽  
Vol 36 (1) ◽  
pp. 132-142 ◽  
Author(s):  
Hazel Mae A Abraham ◽  
Leslie Wolfson ◽  
Nicola Moscufo ◽  
Charles R G Guttmann ◽  
Richard F Kaplan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
White Matter ◽  
Older People ◽  
Older Persons ◽  
Functional Decline ◽  
Vascular Risk Factors ◽  
White Matter Hyperintensity ◽  
Systemic Hypertension ◽  
Vascular Risk

Several potential vascular risk factors exist for the development and accumulation of subcortical white matter disease in older people. We have reported that in older people followed for up to 4 years white matter hyperintensity (WMH) lesions on magnetic resonance imaging nearly doubled in volume and were associated with alterations in mobility and cognitive function. Herein we review the genetic, metabolic, and vascular risk factors that have been evaluated in association with the development and pathogenesis of WMH in older persons. Our research efforts have focused on systemic hypertension, particularly in the out-of-office setting as 24-hour ambulatory blood pressure (BP) has proven to be a stronger indicator of the progression of WMH in older people and the associated functional decline than doctor’s office BP. Based on relations between 24-hour systolic BP levels, the accrual of WMH, and functional decline, we have designed the INFINITY trial, the first interventional study to use ambulatory BP to guide antihypertensive therapy to address this problem in the geriatric population.

Abstract TMP58: Determinants of White Matter Hyperintensity in Acute Ischemic Stroke Patients: The MRI-GENIE Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Anne-Katrin Giese ◽  
Markus D Schirmer ◽  
Adrian V Dalca ◽  
Ramesh Sridharan ◽  
Lisa Cloonan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Ischemic Stroke ◽  
White Matter ◽  
Stroke Risk ◽  
Smoking Status ◽  
Vascular Risk Factors ◽  
White Matter Hyperintensity ◽  
Vascular Risk ◽  
Prior Stroke

Introduction: White matter hyperintensity (WMH) is a highly heritable trait and a significant contributor to stroke risk and severity. Vascular risk factors contribute to WMH severity; however, knowledge of the determinants of WMH in acute ischemic stroke (AIS) is still limited. Hypothesis: WMH volume (WMHv) varies across AIS subtypes and is modified by vascular risk factors. Methods: We extracted WMHv from the clinical MRI scans of 2683 AIS subjects from the MRI-Genetics Interface Exploration (MRI-GENIE) study using a novel fully-automated, volumetric analysis pipeline. Demographic data, stroke risk factors and stroke subtyping for the Causative Classification of Stroke (CCS) were performed at each of the 12 international study sites. WMHv was natural log-transformed for linear regression analyses. Results: Median WMHv was 5.7cm 3 (interquartile range (IQR): 2.2-12.8cm 3 ). In univariable analysis, age (63.1 ± 14.7 years, β=0.04, SE=0.002), prior stroke (10.2%, β=0.66, SE=0.08), hypertension (65.4%, β=0.75, SE=0.05), diabetes mellitus (23.1%, β=0.35, SE=0.06), coronary artery disease (17.6%, β=0.04, SE=0.002), and atrial fibrillation (14.6%, β=0.48, SE=0.07) were significant predictors of WMHv (all p<0.0001), as well as smoking status (52.2%, β=0.15, SE=0.05, p=0.005), race (16.5% Non-Caucasian, β=0.25, SE=0.07) and ethnicity (8.2% Hispanic, β=0.30, SE=0.11) (all p<0.01). In multivariable analysis, age (β=0.04, SE=0.002), prior stroke (β=0.56, SE=0.08), hypertension (β=0.33, SE=0.05), smoking status (β=0.16, SE=0.05), race (β=0.42, SE=0.06), and ethnicity (β=0.34, SE=0.09) were independent predictors of WMHv (all p<0.0001), as well as diabetes mellitus (β=0.13, SE=0.06, p=0.02). WMHv differed significantly (p<0.0001, unadjusted) across CCS stroke subtypes: cardioembolic stroke (8.0cm 3 , IQR: 4.2-15.4cm 3 ), large-artery stroke (6.9cm 3 , IQR: 3.1-14.7cm 3 ), small-vessel stroke (5.8cm 3 , IQR: 2.5-13.5cm 3 ), stroke of undetermined (4.7cm 3 , IQR: 1.6-11.0cm 3 ) or other (2.55cm 3 , IQR: 0.9-8.8cm 3 ) causes. Conclusion: In this largest-to-date, multicenter hospital-based cohort of AIS patients with automated WMHv analysis, common vascular risk factors contribute significantly to WMH burden and WMHv varies by CCS subtype.

Abstract W MP58: The Relationship Between Carotid Stiffness, Diastolic Diameter, and White Matter Hyperintensity Volume: The Northern Manhattan Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Matthew S Markert ◽  
Chuanhui Dong ◽  
David Della-Morte ◽  
Eugene Roberts ◽  
Susanne Bartels ◽  
...  
Keyword(s):  
Risk Factors ◽  
White Matter ◽  
Small Vessel Disease ◽  
Vascular Risk Factors ◽  
Small Vessel ◽  
White Matter Hyperintensity ◽  
Large Artery ◽  
Vascular Risk ◽  
Vessel Disease ◽  
Carotid Stiffness

Background: Changes in the extracranial vasculature may be associated with small vessel disease in the brain. We sought to examine the association of carotid stiffness and carotid diastolic diameter with white matter hyperintensity volume (WMHV), a magnetic resonance imaging (MRI) measure for cerebral small vessel disease, in a multi-ethnic community-based cohort. Methods: We evaluated 1140 stroke-free participants in the Northern Manhattan study who underwent brain MRIs and high-resolution carotid ultrasounds. We used linear regression to examine carotid stiffness and diastolic diameter with WMHV after adjusting for sociodemographics, lifestyle behaviors, and traditional vascular risk factors. Results: Among 1140 participants (mean age: 70.6±9.0 years; 61% women; 15% White, 16% Black, 59% Hispanics), the mean carotid stiffness was 8.19 ± 5.39, mean carotid diastolic diameter was 6.16 ± 0.93 mm, and mean WMHV 0.68 ± 0.84. In a fully adjusted model, diastolic diameter was associated with log-WMHV (β=0.10, p=0.001). In a stratified multivariable linear model, greater carotid arterial stiffness and diastolic diameter were associated with log-WMHV among Hispanics (β=0.15, p=0.005 and β=0.13, p<0.001, respectively), but not among blacks or whites. Conclusion: Greater carotid stiffness and diastolic diameter were associated with greater WMHV independent of demographics and traditional vascular risk factors, especially among Hispanics. Further studies are needed to understand how these large artery characteristics relate to WMH formation and lesion load. Carotid ultrasound may be a useful tool to assess the risk of increased brain white matter disease in a pre-clinical stage.

scholarly journals White Matter Hyperintensity in Different Migraine Subtypes

2021 ◽  
Author(s):  
Larisa A. Dobrynina ◽  
Anastasia D. Suslina ◽  
Mariia V. Gubanova ◽  
Anastasia V. Belopasova ◽  
Anastasia N. Sergeeva ◽  
...  
Keyword(s):  
Risk Factors ◽  
White Matter ◽  
Brain Mri ◽  
Vascular Complications ◽  
Diagnostic Value ◽  
Vascular Risk Factors ◽  
White Matter Hyperintensity ◽  
Control Group ◽  
Vascular Risk ◽  
Different Types

Abstract Background: The diagnostic value of white matter hyperintensities (WMH) in different types of migraine are unknown. Objective: To evaluate the WMH pattern of different subtypes in migraine patients with no vascular risk factors.Methods: 92 migraine patients (73 females, mean age 34.6±8.9; 61 episodic migraine, 31 chronic migraine, 36 migraine with aura, 56 migraine without aura) without vascular risk factors underwent brain MRI (3T). We also included a matched healthy control group with no migraine (n=24).Results: The prevalence of WMH in different types of migraine was similar and ranged from 38.7% to 44.4%; the control group showed no WMH at all. Lesions were located within frontal, parietal and temporal lobes (in order of decreasing incidence) in juxtacortical and/or deep white matter. WMH appeared as round or slightly elongated foci with a median size of 2.5 mm [1.5; 3]. Total number, size and prevalence of WMH by lobes and white matter regions were similar between groups, and no interaction with age or sex was found. The number of lesions within the frontal lobe juxtacortical white matter correlated with the age of patients (r= 0.331, p=0.001) and the duration since migraine onset (r=0.264, p=0.012). Conclusion: Patients with different migraine subtypes and without vascular risk factors are characterized by a similar pattern of WMH in the absence of subclinical infarctions or microbleedings. Therefore, WMH have no relevant prognostic value regarding the course of migraine and vascular complications. WMH pattern may be used to differentiate migraine as a primary disorder and other disorders with migraine-like headache and WMH.

scholarly journals White matter hyperintensity in different migraine subtypes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
L. A. Dobrynina ◽  
A. D. Suslina ◽  
M. V. Gubanova ◽  
A. V. Belopasova ◽  
A. N. Sergeeva ◽  
...  
Keyword(s):  
Risk Factors ◽  
White Matter ◽  
Brain Mri ◽  
Vascular Complications ◽  
Diagnostic Value ◽  
Vascular Risk Factors ◽  
White Matter Hyperintensity ◽  
Control Group ◽  
Vascular Risk ◽  
Different Types

AbstractThe diagnostic value of white matter hyperintensities (WMH) in different types of migraineare unknown. To evaluate the WMH pattern of different subtypes in migraine patients with no vascular risk factors. 92 migraine patients (73 females, mean age 34.6 ± 8.9; 61 episodic migraine, 31 chronic migraine, 36 migraine with aura, 56 migraine without aura) without vascular risk factors underwent brain MRI (3 T). We also included a matched healthy control group with no migraine (n = 24). The prevalence of WMH in different types of migraine was similar and ranged from 38.7 to 44.4%; the control group showed no WMH at all. Lesions were located within frontal, parietal and temporal lobes (in order of decreasing incidence) in juxtacortical and/or deep white matter. WMH appeared as round or slightly elongated foci with a median size of 2.5 mm [1.5; 3]. Total number, size and prevalence of WMH by lobes and white matter regions were similar between groups, and no interaction with age or sex was found. The number of lesions within the frontal lobe juxtacortical white matter correlated with the age of patients (r = 0.331, p = 0.001) and the duration since migraine onset (r = 0.264, p = 0.012). Patients with different migraine subtypes and without vascular risk factors are characterized by a similar pattern of WMH in the absence of subclinical infarctions or microbleedings. Therefore, WMH have no relevant prognostic value regarding the course of migraine and vascular complications. WMH pattern may be used to differentiate migraine as a primary disorder and other disorders with migraine-like headache and WMH.

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