CEREBRAL WHITE MATTER DISEASE IN PATIENTS WITH MALIGNANCY: PML VERSUS TOXIC LEUCOENCEPHALOPATHY DUE TO CHEMOTHERAPY

Introduction: Cerebral microbleeds (CMBs) have been increasingly reported in patients receiving extracorporeal membrane oxygenation (ECMO) support. Both, CMBs and cerebral white-matter disease (WMD) are thought to be a result of microvascular lipo-hyalinosis; as commonly seen in an aging brain. The pathogenesis of microbleeds after ECMO, has not yet been definitively established. We sought to examine the relationship between cerebral WMD burden and microbleeds after ECMO-support at a single tertiary referral academic hospital with high volumes of ECMO patients. Methods: All patients receiving venovenous (vv) and venoarterial (va) ECMO between January 2013 to January 2018 were retrospectively examined. The distribution of white matter hyperintensities was quantified using the Walhund age-related white matter changes (ARWMC) scale and correlated with the presence of cerebral microbleeds on brain MRI studies with Susceptibility Weighted Imaging (SWI) performed shortly after cessation of ECMO. Results: A total of 307 ECMO patients were reviewed, among whom 44 patients (vv:va= 13:31; male:female= 29:15) received at-least one MRI-brain study with SWI sequences after ECMO decannulation. The median duration of ECMO support was 4 days (range 1-25 days), with median duration from decannulation-to-MRI being 11.5 days (range 3-724 days). Microbleeds were present in 77.3% (n=34) patients, with 38.2% (n=13), 14.7% (n=5), and 47.1% (n=16) having mild (<10), moderate (10-30) and severe (>30) CMBs respectively. The median Walhund ARWMC score was 1 (range 0-22). Age and sex adjusted Walhund scores were not found predictive of CMB presence (p=0.578 [0.90-1.19]). Of 44 patients with at-least one post-ECMO MRI, 10 patients had a follow-up MRI scan at a median duration of 4 months (range 0.22-55 months); all of whom had unchanged CMB burden. At 10-month median clinical follow-up (range 0-76 months), none of the 34 patients with CMBs on initial MRI-study had presented with an intracranial hemorrhage. Conclusion: Development of CMBs after ECMO support is independent of microvascular lipo-hyalinosis, as estimated from cerebral white-matter disease burden. This requires further study in a larger sample-size.

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344 The Relationship between Late Life Depressive Symptoms and Cerebral White Matter Disease is Modified by Systemic and Orthostatic Blood Pressure

Age and Ageing ◽

10.1093/ageing/afz102.71 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii1-iii16

Author(s):

Robert Briggs ◽

Anne Buckley ◽

Silvin Knight ◽

Jim Meaney ◽

Sean Kennelly ◽

...

Keyword(s):

Blood Pressure ◽

Depressive Symptoms ◽

White Matter ◽

Brain Mri ◽

Depression Scale ◽

Late Life ◽

Community Dwelling ◽

Cerebral White Matter ◽

White Matter Disease ◽

The Relationship

Abstract Background Cerebral white matter hyperintensity (WMH) burden is a key biological risk factor underpinning late life depression (LLD) and cerebral hypoperfusion has been identified as an important cause of WMH. The aim of this study therefore is to clarify if orthostatic hypotension (OH) and lower systemic blood pressure (BP), both of which cause reduced cerebral blood flow, modify the relationship between depression and cerebral white matter disease in a cohort of community-dwelling older people aged ≥70 years. Methods This study uses data from wave 3 of TILDA. Participants were included if they were aged ≥70 years and had undergone assessment for depressive symptoms, brain MRI and cardiovascular measures. Depressive symptoms were measured using the 8-item Centre for Epidemiological Studies Depression Scale. Scheltens Score was used by a trained radiologist to calculate overall WMH burden. Orthostatic BP was measured by active stand. OH was defined as a drop in Systolic BP≥20 mmHg or drop in diastolic BP≥10 mmHg at 30, 60 or 90 seconds post standing. Results Participants with depressive symptoms (8%, 16/202) had a significantly higher burden of WMH measured by Scheltens Score (14.6 (95% CI:11.0–18.2) vs. 11.0 (95% CI:10.1–11.8); p=0.0211). Two-way interaction models demonstrated that the association between depressive symptoms and WMH burden is significant only in those with co-existing OH. Similarly, the two-way interaction between depressive symptoms and systolic BP shows that this association remains statistically significant only in those with both depressive symptoms and lower BP, i.e. <130 mm Hg. Conclusion This study demonstrates that depressive symptoms are associated with cerebral WMH in a cohort of community-dwelling people aged ≥70 years but this relationship is modified by co-existing OH or lower BP. Identifying the processes that lead to WMH accumulation and progression in depression is crucial in order to inform strategies aimed at preventing and ameliorating LLD.

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