scholarly journals Spatial signature of white matter hyperintensities in stroke patients

2018 ◽  
Author(s):  
Markus D. Schirmer ◽  
Anne-Katrin Giese ◽  
Panagiotis Fotiadis ◽  
Mark R. Etherton ◽  
Lisa Cloonan ◽  
...  
Keyword(s):  
White Matter ◽  
Cerebral Artery ◽  
Neurological Diseases ◽  
Relative Increase ◽  
White Matter Hyperintensity ◽  
Vascular Territory ◽  
Stroke Patients ◽  
Stroke Subtype ◽  
Mri Scans ◽  
Spatial Specificity

AbstractPurposeWhite matter hyperintensity (WMH) is a common phenotype across a variety of neurological diseases, particularly prevalent in stroke patients; however, vascular territory dependent variation in WMH burden has not yet been identified. Here, we sought to investigate the spatial specificity of WMH burden in patients with acute ischemic stroke (AIS).Materials and MethodsWe created a novel age-appropriate high-resolution brain template and anatomically delineated the cerebral vascular territories. We used WMH masks derived from the clinical T2 FLAIR MRI scans and spatial normalization of the template to discriminate between WMH volume within each subject’s anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) territories. Linear regression modeling including age, sex, common vascular risk factors, and TOAST stroke subtypes was used to assess for spatial specificity of WMH volume (WMHv) in a cohort of 882 AIS patients.ResultsMean age of this cohort was 65.23±14.79 years, 61.7% were male, 63.6% were hypertensive, 35.8% never smoked. Mean WMHv was 11.58c +/-13.49 cc. There were significant differences in territory-specific, relative to global, WMH burden. In contrast to PCA territory, age (0.018±0.002, p<0.001) and small-vessel stroke subtype (0.212±0.098, p<0.001) were associated with relative increase of WMH burden within the anterior (ACA and MCA) territories, whereas male sex (−0.275±0.067, p<0.001) was associated with a relative decrease in WMHv.ConclusionsOur data establish the spatial specificity of WMH distribution in relation to vascular territory and risk factor exposure in AIS patients and offer new insights into the underlying pathology.

scholarly journals Increased serum QUIN/KYNA is a reliable biomarker of post-stroke cognitive decline

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Adrien Cogo ◽  
Gabrielle Mangin ◽  
Benjamin Maïer ◽  
Jacques Callebert ◽  
Mikael Mazighi ◽  
...  
Keyword(s):  
White Matter ◽  
Cerebral Artery ◽  
Quinolinic Acid ◽  
Neuronal Death ◽  
Artery Occlusion ◽  
Serum Biomarkers ◽  
Diabetic Mice ◽  
Stroke Patients ◽  
Cerebral Artery Occlusion

Abstract Background Strokes are becoming less severe due to increased numbers of intensive care units and improved treatments. As patients survive longer, post-stroke cognitive impairment (PSCI) has become a major health public issue. Diabetes has been identified as an independent predictive factor for PSCI. Here, we characterized a clinically relevant mouse model of PSCI, induced by permanent cerebral artery occlusion in diabetic mice, and investigated whether a reliable biomarker of PSCI may emerge from the kynurenine pathway which has been linked to inflammatory processes. Methods Cortical infarct was induced by permanent middle cerebral artery occlusion in male diabetic mice (streptozotocin IP). Six weeks later, cognitive assessment was performed using the Barnes maze, hippocampi long-term potentiation using microelectrodes array recordings, and neuronal death, white matter rarefaction and microglia/macrophages density assessed in both hemispheres using imunohistochemistry. Brain and serum metabolites of the kynurenin pathway were measured using HPLC and mass fragmentography. At last, these same metabolites were measured in the patient’s serum, at the acute phase of stroke, to determine if they could predict PSCI 3 months later. Results We found long-term spatial memory was impaired in diabetic mice 6 weeks after stroke induction. Synaptic plasticity was completely suppressed in both hippocampi along with increased neuronal death, white matter rarefaction in both striatum, and increased microglial/macrophage density in the ipsilateral hemisphere. Brain and serum quinolinic acid concentrations and quinolinic acid over kynurenic acid ratios were significantly increased compared to control, diabetic and non-diabetic ischemic mice, where PSCI was absent. These putative serum biomarkers were strongly correlated with degradation of long-term memory, neuronal death, microglia/macrophage infiltration and white matter rarefaction. Moreover, we identified these same serum biomarkers as potential predictors of PSCI in a pilot study of stroke patients. Conclusions we have established and characterized a new model of PSCI, functionally and structurally, and we have shown that the QUIN/KYNA ratio could be used as a surrogate biomarker of PSCI, which may now be tested in large prospective studies of stroke patients.

Metabolic Syndrome is Associated with White Matter Hyperintensity in Stroke Patients

2017 ◽  
Vol 18 (3) ◽  
pp. 277-283
Author(s):  
Zheng Zhang ◽  
Wan-Li Zhang ◽  
Jia Li ◽  
Mei-Juan Xiao
Keyword(s):  
Metabolic Syndrome ◽  
White Matter ◽  
Acute Stroke ◽  
Old Age ◽  
Univariate Analysis ◽  
Serum Triglyceride ◽  
White Matter Hyperintensity ◽  
Acute Ischemia ◽  
Stroke Patients ◽  
Cross Sectional

Some risk factors of stroke may play a role in white matter hyperintensity (WMH). Metabolic syndrome (MetS) is a recognised risk factor of stroke, but it is controversial whether MetS is also associated with WMH. We examined the association of MetS with the prevalence of WMH in acute stroke patients. We conducted a cross-sectional study in 246 acute ischemia stroke patients. The patients with acute stroke were clinically evaluated, including waistline circumference, blood pressure, glycaemia, serum triglyceride and high density lipoprotein cholesterol level. The degree of WMH was assessed by Fluid-attenuated inversion recovery (FLAIR) sequence of magnetic resonance imaging (MRI) scans. MetS was diagnosed using the criteria by the National Cholesterol Education Adult Treatment Panel III. MetS was the independent variable evaluated in Binary regression analyses. It is found that old age (>60 years old), MetS and smoking were significantly associated with WMH in univariate analysis (p < .05). Spearman rank correlation showed that old age and MetS are related to WMH (r = 0.18, p = .005 and r = 0.18, p = .004, respectively). Hypertension is weakly but not significantly associated with WMH in correlation analysis (r = 0.11, p = .08). In multiple regression analysis, age and MetS remained independently associated with WMH (OR = 7.6, 95% CI 0.2–0.7 and OR = 11.7, 95% CI 0.1–0.5). Hypertension and hyperglycaemia tend to be associated but not significantly with WMH (p = .07, p = .08). Other MetS components such as large waist circumference and dyslipidaemia showed no association with WMH. After adjustment for age, WMH is significantly associated with MetS in stroke patients. Hypertension and hyperglycaemia tend to associated but not significantly with WMH in stroke patients.

scholarly journals Antioxidative activity of statins and HDL-PON1 association in lacunar ischemic stroke with and without white matter hyperintensity

2021 ◽  
Keyword(s):  
Antioxidant Activity ◽  
Ischemic Stroke ◽  
White Matter ◽  
Medical Center ◽  
Density Lipoprotein ◽  
Statin Treatment ◽  
Paraoxonase 1 ◽  
White Matter Hyperintensity ◽  
Pon1 Activity ◽  
Stroke Patients

Purpose: Statins (HMG-coA reductase inhibitors) protect vessels from atherosclerosis through various mechanisms, but the clinical significance of statin-induced high-density lipoprotein cholesterol (HDL) changes has not been established. We evaluated the effects of statin treatment on the antioxidative activities of HDLs in ischemic stroke patients with and without white matter hyperintensity (WMH). Methods: From January to December in 2013, eighty-two ischemic stroke patients (57 men, 25 women; mean age 67.0 ± 11.8 years) at the Wonkwang Medical Center were recruited retrospectively and antioxidant activity was assessed via paraoxonase 1 (PON1) activity. We studied changes in the patients’ lipid profiles and assessed PON1 activity in patients with and without WMH, at baseline and 8 weeks after treatment with rosuvastatin 10 mg/d. Results: All patients evaluated antioxidant activity using PON1 activity at admission. After 8 weeks of rosuvastatin treatment, the mean HDL concentration increased to 0.83± 10.1 mg/dL. The HDL levels increased in 54 patients (64.3%) and decreased in 30 patients (35.7%). PON1 activity increased to 15.0% in all patients, regardLess of WMH after rosuvastatin treatment (+ 25.4% in subjects without WMH; P < 0.001). Baseline PON1 activity modestly correlated with HDL levels (r = 0.365, P = 0.019); however, PON1 activity after treatment did not correlate with HDL levels (r = 0.149, P = 0.347). Conclusion: Our findings suggest that statins increase antioxidant activity, especially assessed via PON1 activity, in ischemic stroke patients who did not have WMH.

scholarly journals Association of White Matter Hyperintensity Markers on MRI and Long-term Risk of Mortality and Ischemic Stroke

Neurology ◽  
2021 ◽  
Vol 96 (17) ◽  
pp. e2172-e2183 ◽  
Author(s):  
Rashid Ghaznawi ◽  
Mirjam I. Geerlings ◽  
Myriam Jaarsma-Coes ◽  
Jeroen Hendrikse ◽  
Jeroen de Bresser ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Cox Regression ◽  
Brain Mri ◽  
Arterial Disease ◽  
White Matter Hyperintensity ◽  
Risk Of Mortality ◽  
Mri Scans

ObjectiveTo determine whether white matter hyperintensity (WMH) markers on MRI are associated with long-term risk of mortality and ischemic stroke.MethodsWe included consecutive patients with manifest arterial disease enrolled in the Second Manifestations of Arterial Disease–Magnetic Resonance (SMART-MR) study. We obtained WMH markers (volume, type, and shape) from brain MRI scans performed at baseline using an automated algorithm. During follow-up, occurrence of death and ischemic stroke was recorded. Using Cox regression, we investigated associations of WMH markers with risk of mortality and ischemic stroke, adjusting for demographics, cardiovascular risk factors, and cerebrovascular disease.ResultsWe included 999 patients (59 ± 10 years; 79% male) with a median follow-up of 12.5 years (range 0.2–16.0 years). A greater periventricular or confluent WMH volume was independently associated with a greater risk of vascular death (hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.13–1.47) for a 1-unit increase in natural log-transformed WMH volume and ischemic stroke (HR 1.53, 95% CI 1.26–1.86). A confluent WMH type was independently associated with a greater risk of vascular (HR 1.89, 95% CI 1.15-3.11) and nonvascular death (HR 1.65, 95% CI 1.01–2.73) and ischemic stroke (HR 2.83, 95% CI 1.36-5.87). A more irregular shape of periventricular or confluent WMH, as expressed by an increase in concavity index, was independently associated with a greater risk of vascular (HR 1.20, 95% CI 1.05–1.38 per SD increase) and nonvascular death (HR 1.21, 95% CI 1.03–1.42) and ischemic stroke (HR 1.28, 95% CI 1.05–1.55).ConclusionsWMH volume, type, and shape are associated with long-term risk of mortality and ischemic stroke in patients with manifest arterial disease.

scholarly journals The associations between bone mineral density and cerebral white matter hyperintensity in elderly stroke patients

2018 ◽  
Vol 2 (3) ◽  
pp. 117-123
Author(s):  
Ji-Sun Kim ◽  
Minjik Kim ◽  
Sung Hoon Kang ◽  
Kyungmi Oh ◽  
Sangil Suh ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
White Matter ◽  
Bone Mineral ◽  
White Matter Hyperintensity ◽  
Cerebral White Matter ◽  
Mineral Density ◽  
Stroke Patients

Spaceflight-induced changes in white matter hyperintensity burden in astronauts

Neurology ◽  
2017 ◽  
Vol 89 (21) ◽  
pp. 2187-2191 ◽  
Author(s):  
Noam Alperin ◽  
Ahmet M. Bagci ◽  
Sang H. Lee
Keyword(s):  
White Matter ◽  
Brain Tissue ◽  
Space Shuttle ◽  
Brain Mri ◽  
Space Station ◽  
Automated Analysis ◽  
White Matter Hyperintensity ◽  
Long Duration ◽  
Mri Scans ◽  
Fluid Attenuated Inversion Recovery

Objective:To assess the effect of weightlessness and the respective roles of CSF and vascular fluid on changes in white matter hyperintensity (WMH) burden in astronauts.Methods:We analyzed prespaceflight and postspaceflight brain MRI scans from 17 astronauts, 10 who flew a long-duration mission on the International Space Station (ISS) and 7 who flew a short-duration mission on the Space Shuttle. Automated analysis methods were used to determine preflight to postflight changes in periventricular and deep WMH, CSF, and brain tissue volumes in fluid-attenuated inversion recovery and high-resolution 3-dimensional T1-weighted imaging. Differences between cohorts and associations between individual measures were assessed. The short-term reversibility of the identified preflight to postflight changes was tested in a subcohort of 5 long-duration astronauts who had a second postflight MRI scan 1 month after the first postflight scan.Results:Significant preflight to postflight changes were measured only in the long-duration cohort and included only the periventricular WMH and ventricular CSF volumes. Changes in deep WMH and brain tissue volumes were not significant in either cohort. The increase in periventricular WMH volume was significantly associated with an increase in ventricular CSF volume (ρ = 0.63, p = 0.008). A partial reversal of these increases was observed in the long-duration subcohort with a 1-month follow-up scan.Conclusions:Long-duration exposure to microgravity is associated with an increase in periventricular WMH in astronauts. This increase was linked to an increase in ventricular CSF volume documented in ISS astronauts. There was no associated change in or abnormal levels of WMH volumes in deep white matter as reported in U-2 high-altitude pilots.

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