Abstract WP184: Differential Risk of Embolic Stroke Among Stroke Free Community Dwellers With Distinct Categories of Subcortical Infarct

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jose Gutierrez ◽  
Erin R Kulick ◽  
Maria Santiago ◽  
Tatjana Rundek ◽  
Ralph Sacco ◽  
...  
Keyword(s):  
Small Vessel Disease ◽  
Brain Mri ◽  
Embolic Stroke ◽  
Intracranial Artery ◽  
Mri Imaging ◽  
Brain Infarcts ◽  
Stroke Subtypes ◽  
Hazard Ratios ◽  
Artery Disease ◽  
Predicted Risk

Introduction: Cortically-based subclinical infarcts are considered risks for embolic stroke, but few studies have stratified subcortical SBI by penetrating versus medullary artery location. We hypothesized that subclinical medullary infarcts are due to small emboli and are predictors of embolic stroke. Methods: Stroke-free participants in the Northern Manhattan Study underwent a brain MRI to assess for subclinical biomarkers of vascular disease. Subcortical brain infarcts were defined voids >3mm on axial T1 and FLAIR images, with perilesional FLAIR hyperintensities referred to as pathology-informed subclinical brain infarcts (PI-SBI). Each subcortical PI-SBI was rated as penetrating or medullary by two vascular neurologists blinded to stroke subtypes. Participants were followed prospectively for incident stroke. Two vascular neurologists ascertained ischemic stroke subtypes independent of brain MRI imaging at baseline. Embolic stroke required a cardiac source or based on a superficial location. Cox proportional risk models generated hazard ratios and 95% confidence intervals (HR, 95% CI) adjusting for age, sex, ethnicity and traditional vascular risk. Results: The sample included 1290 NOMAS participants (mean age 71±9 years, 60% women, 66% Hispanic, 75% with hypertension) who were followed on average 9±3 years. At baseline, 19% of participants had PI-SBI (11% medullary artery, 7% penetrating artery and 3% cortical). During follow up, 80 participants (6.2%) had stroke (3.6% embolic, 2.4% due to intracranial artery disease (i.e. small and large), and 0.2% other subtypes). In a fully adjusted model, medullary artery (2.04, 1.00-4.14) and not penetrating artery PI-SBI (1.64, 0.99-2.70) predicted risk of embolic stroke. Distal field PI-SBI (i.e. cortical + medullary artery) were even more robust predictors of embolic stroke (2.17, 1.11-4.25). Penetrating artery (1.98, 1.09-3.61) and not medullary artery PI-SBI (HR 1.03, 0.34-3.06) predicted risk of intracranial artery stroke. Conclusions: Subtyping PI-SBI by location and plausible mechanisms may help with risk stratification for clinical trials testing stroke prevention strategies. Our data suggest not all subcortical infarcts are due to small vessel disease.

EXPRESS: Evolving Ischemic Stroke Subtypes in 15 years: A hospital-based observational study

2021 ◽  
pp. 174749302110059
Author(s):  
Yiu Ming Bonaventure Ip ◽  
Lisa Au ◽  
Yin Yan Anne Chan ◽  
Florence Fan ◽  
Hing Lung Ip ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Recurrence Rate ◽  
Small Vessel Disease ◽  
Mainland China ◽  
Cardioembolic Stroke ◽  
Large Artery ◽  
Risk Factor Control ◽  
Stroke Subtypes ◽  
Artery Disease ◽  
Ischemic Attack

Background: Depicting the time trends of ischemic stroke subtypes may inform healthcare resource allocation on etiology-based stroke prevention and treatment. Aim: To reveal the evolving ischemic stroke subtypes from 2004 to 2018. Methods: We determined the stroke etiology of consecutive first-ever transient ischemic attack or ischemic stroke patients admitted to a regional hospital in Hong Kong from 2004 to 2018. We analyzed the age-standardized incidences and the 2-year recurrence rate of major ischemic stroke subtypes. Results: Among 6940 patients admitted from 2004 to 2018, age-standardized incidence of ischemic stroke declined from 187.0 to 127.4 per 100,000 population (p<0.001), driven by the decrease in large artery disease (43.0 to 9.67 per 100,000 population (p<0.001)) and small vessel disease (71.9 to 45.7 per 100,000 population (p<0.001)). Age-standardized incidence of cardioembolic stroke did not change significantly (p=0.2). Proportion of cardioembolic stroke increased from 20.4% in 2004-2006 to 29.3% in 2016-2018 (p<0.001). 2-year recurrence rate of intracranial atherothrombotic stroke reduced from 19.3% to 5.1% (p<0.001) with increased prescriptions of statin (p<0.001) and dual anti-platelet therapy (<0.001). In parallel with increased anticoagulation use across the study period (p<0.001), the 2-year recurrence of AF-related stroke reduced from 18.9% to 6% (p<0.001). Conclusion: Etiology-based risk factor control might have led to the diminishing stroke incidences related to atherosclerosis. To tackle the surge of AF-related strokes, arrhythmia screening, anticoagulation usage and mechanical thrombectomy service should be reinforced. Comparable preventive strategies might alleviate the enormous stroke burden in mainland China.

scholarly journals Rivaroxaban versus aspirin for prevention of covert brain infarcts in patients with embolic stroke of undetermined source: NAVIGATE ESUS MRI substudy

2021 ◽  
pp. 174749302110580
Author(s):  
Mukul Sharma ◽  
Eric E Smith ◽  
Lesly A Pearce ◽  
Kanjana S Perera ◽  
Scott E Kasner ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Treatment Effects ◽  
Brain Mri ◽  
Embolic Stroke ◽  
Brain Infarct ◽  
Unique Identifier ◽  
Stroke Treatment ◽  
Brain Infarcts ◽  
Neurological Morbidity ◽  
To Receive

Background Covert brain infarcts are associated with important neurological morbidity. Their incidence in patients with embolic stroke of undetermined source (ESUS) is unknown. Aims To assess the incidence of covert brain infarcts and cerebral microbleeds using MRI in a prospective substudy of the NAVIGATE ESUS randomized trial and to evaluate the effects of antithrombotic therapies. Methods At 87 sites in 15 countries, substudy participants were randomly assigned to receive rivaroxaban 15 mg daily or aspirin 100 mg daily and underwent brain MRI near randomization and after study termination. The primary outcome was incident brain infarct (clinical ischemic stroke or covert brain infarct). Brain infarcts and microbleeds were ascertained centrally by readers unaware of treatment. Treatment effects were estimated using logistic regression. Results Among the 718 substudy participants with interpretable, paired MRIs, the mean age was 67 years and 61% were men with a median of 52 days between the qualifying ischemic stroke and randomization and a median of seven days between randomization and baseline MRI. During the median (IQR) 11 (12) month interval between scans, clinical ischemic strokes occurred in 27 (4%) participants, while 60 (9%) of the remaining participants had an incident covert brain infarct detected by MRI. Assignment to rivaroxaban was not associated with reduction in the incidence of brain infarct (OR 0.77, 95% CI 0.49, 1.2) or of covert brain infarct among those without clinical stroke (OR 0.85, 95% CI 0.50, 1.4). New microbleeds were observed in 7% and did not differ among those assigned rivaroxaban vs. aspirin (HR 0.95, 95% CI 0.52–1.7). Conclusions Incident covert brain infarcts occurred in twice as many ESUS patients as a clinical ischemic stroke. Treatment with rivaroxaban compared with aspirin did not significantly reduce the incidence of covert brain infarcts or increase the incidence of microbleeds, but the confidence intervals for treatment effects were wide. Registration: https://www.clinicaltrials.gov . Unique identifier: NCT 02313909

scholarly journals Atrial Fibrillation, Stroke, and Silent Cerebrovascular Disease: A Population-Based MRI Study

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012675
Author(s):  
Lina Rydén ◽  
Simona Sacuiu ◽  
Hanna Wetterberg ◽  
Jenna Najar ◽  
Xinxin Guo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Small Vessel Disease ◽  
Brain Mri ◽  
Population Based ◽  
Cerebrovascular Diseases ◽  
Register Data ◽  
Self Report ◽  
Birth Date ◽  
Intracranial Volume ◽  
Brain Infarcts

Background and Objectives:Atrial fibrillation (AF) has been associated with cognitive decline and dementia. However, the mechanisms behind these associations are not clear. Examination of cerebrovascular pathology on MRI may shed light on how AF affects the brain. This study aimed to determine whether AF is associated with a broad range of cerebrovascular diseases, beyond the well-known association with symptomatic stroke, including silent infarcts and markers of small vessel disease, e.g. cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), and lacunes, in a population-based sample of 70-year-olds.Methods:Data were obtained from the Gothenburg H70 Birth Cohort Studies, where individuals are invited based on birth-date. This study has a cross-sectional design and includes individuals born 1944 who underwent structural brain MRI in 2014-17. AF diagnoses were based on self-report, EKG, and register data. Symptomatic stroke was based on self-report, proxy-interviews, and register data. Brain infarcts and CMBs were assessed by a radiologist. WMH volumes were measured on FLAIR images using the Lesion Segmentation Tool. Multivariate logistic regression was used to study the association between AF and infarcts/CMBs, and multivariate linear regression was used to study the association between AF and WMHs.Results:A total of 776 individuals were included and 65 (8.4%) had AF. AF was associated with symptomatic stroke (OR 4.5, 95% CI 2.1-9.5), and MRI findings of large infarcts (OR 5.0, 95% CI 1.5-15.9), lacunes (OR 2.7, 95% CI 1.2-5.6), and silent brain infarcts (OR 3.5; 95% CI 1.6-7.4). Among those with symptomatic stroke, individuals with AF had larger WMH volumes (0.0137 ml/total intracranial volume (TIV), 95% CI 0.0074-0.0252) compared to those without AF (0.0043 ml/TIV, 95% CI 0.0029-0.0064). There was no association between AF and WMH volumes among those without symptomatic stroke. In addition, AF was associated to CMBs in the frontal lobe.Discussion:AF was associated with broad range of cerebrovascular pathologies. Further research is needed to establish whether cerebrovascular MRI markers can be added to current treatment guidelines to further personalise anticoagulant treatment in AF patients and to further characterize the pathogenetic processes underlying the associations between AF and cerebrovascular diseases, as well as dementia.

Abstract P653: Intracranial Artery Calcification Variations by Stroke Subtypes

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Kursat Gurel ◽  
Farid Khasiyev ◽  
Marimer Santiago ◽  
Antonio Spagnolo-Allende ◽  
Daniel Bos ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Radiological Finding ◽  
Clinical Information ◽  
Older Age ◽  
Large Artery ◽  
Intracranial Artery ◽  
Small Artery ◽  
Stroke Subtypes ◽  
Intracranial Artery Calcification ◽  
Artery Disease

Introduction: Intracranial artery calcification (IAC) is a common radiological finding on Computed Tomography (CT) scan. Although IAC occurs with aging, it is uncertain whether IAC varies by stroke subtypes. Method: We included patients admitted to our hospital with acute stroke. We quantified calcification volume of both clinoid and siphon carotid arteries, vertebral arteries at the V4 segment, and the basilar artery using an in-house quantification tool for non-contrast brain CT. Stroke etiological subtypes were determined according to the Trial of Organon in Acute Stroke Trial (TOAST) classification system independent of the calcification quantification. Demographic and clinical information was extracted from the medical records. We determined the prevalence of IAC in 51% of patients. (31% anterior, 7% posterior, and 14 % in both circulations) Result: We included 694 patients with stroke history (mean age 68 ± 16, range 21-101, 55% women, 71% nonwhite or mixed). IAC was associated with male sex (OR 1.47 [95%-CI 1.41-2.08), older age (OR 1.05 [95%-CI, 1.04-1.06]), hypertension (OR 1.55 [95%-CI, 1.01-2.36], dyslipidemia (OR 1.54 [95%-CI, 1.06-2.25]), and smoking (OR 1.79 [95%-CI, 1.18-2.71]). Anterior IAC was associated with dyslipidemia (OR 1.57 [95%-CI, 1.08-2.28], smoking (1.9 [95%-CI, 1.25-2.88]), and older age (OR 1.05 [95%-CI, 1.36-1.66). Posterior IAC was associated with myocardial infarction (OR 1.58 [95%-CI, 1.01-2.47] and older age (OR 1.02 [95%-CI, 1.01-1.03]. In multivariate analyses, any IAC was associated with small artery disease stroke (OR 1.01[95%-CI, 1.41-3.98]). Stratifying by circulations, however, demonstrated that the association was only with posterior (OR 1.22[95%-CI, 1.02-2.28]) and not anterior IAC (OR 1.20[95%-CI, 0.86-1.1.69]). There was no association between IAC and intracranial large artery stenoses OR (1.22[95%-CI, 0.78-1.1.92]). Conclusion: IAC is a marker of arterial disease, and its prevalence relates to vascular risk factors and small artery disease strokes. Understanding the mechanism by which IAC may relate to small artery disease may help us understand small artery stroke physiopathology and discover novel therapies for its treatment.

Abstract P264: Trends in Diagnostic Testing and Mechanism of Stroke Determination

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Felipe De Los Rios La Rosa ◽  
Jane C Khoury ◽  
Kathleen S Alwell ◽  
Mary Haverbusch ◽  
Daniel Woo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Small Vessel Disease ◽  
Brain Mri ◽  
Diagnostic Testing ◽  
Population Based ◽  
Small Vessel ◽  
Patient Specific ◽  
Large Artery ◽  
Vessel Disease ◽  
Artery Disease

Introduction: A main goal for hospital admission following acute ischemic stroke (AIS) is to establish the mechanism of stroke (MoS) allowing for patient specific secondary prevention of stroke interventions. We previously reported on diagnostic testing trends and MoS determination from 1993 through 2010. We updated this analysis with 2015 data to better understand the effects of trends in diagnostic testing on MoS determination. Methods: Patients with AIS aged > 20 years from all study time periods (Table) of the population based GCNKSS were included. Charts were abstracted in a systematic way for tests performed during the hospital stay. Only first-ever ischemic stroke cases, evaluated in an emergency department were used for this analysis. Stroke experts reviewed these events and adjudicated the mechanism of stroke according to modified TOAST criteria. We looked at and compared trends for testing and MoS. Results: Our analysis included 7226 patients. Basic patient demographics, MoS categories and tests across study periods are detailed in the Table. There were significant increases in EKG (7%), TTE (35%), TEE (7%), HCT (4%), brain MRI (65%), MRA (30%) and CTA (28%). Across study periods, cardioembolic (4.1%), small vessel disease (3%), large artery disease (0.9%) and other (1.5%) MoS increased while unknown MoS decreased (-9.5%). Discussion: From 1993/1994 to 2015 there has been a significant increase of in-hospital testing in AIS and decreases in undetermined MoS. Cardioembolic and small vessel disease MoS categories increased the most. Despite a significant increase in vessel imaging, large artery disease and “other determined” MoS categories are largely unchanged. Further research is required to elucidate the occult MoS underlying the undetermined category. Based on our analysis it appears unlikely to be significantly associated with our current definition of stroke associated with large artery disease defined as ≥ 50% ipsilateral stenosis.

EXPRESS: Long-term Neurobehavioral Correlates of Brain Cortical Microinfarcts in a Memory Clinic Cohort in Singapore

2021 ◽  
pp. 174749302110062
Author(s):  
Xin Xu ◽  
Cheuk Ni Kan ◽  
Christopher Li-Hsian Chen ◽  
Saima Hilal
Keyword(s):  
White Matter Hyperintensities ◽  
Small Vessel Disease ◽  
Brain Mri ◽  
Functional Decline ◽  
Memory Clinic ◽  
Neuropsychiatric Inventory ◽  
Clinical Dementia Rating ◽  
Clinical Assessments ◽  
The Impact

Background Cortical cerebral microinfarcts (CMIs) are a small vessel disease (SVD) biomarker underlying cognitive impairment and dementia. However, it is unknown whether CMIs are associated with neuropsychiatric disturbances, and whether its effects are independent of conventional SVD markers. Aims We investigated the associations of CMI burden with incidence and progression of neuropsychiatric subsyndromes (NPS) in a memory clinic cohort of elderly in Singapore. Methods In this prospective cohort, 496 subjects underwent detailed neuropsychological and clinical assessments, 3T brain MRI, and Neuropsychiatric Inventory assessment at baseline and 2 years later. Cortical CMIs and other SVD markers, including white matter hyperintensities, lacunes, and microbleeds, were graded according to established criteria. NPS were clustered into subsyndromes of Hyperactivity, Psychosis, Affective, and Apathy following prior findings. Functional decline was determined using the Clinical Dementia Rating (CDR) scale. Results The presence of multiple CMIs (≥2) was associated with higher NPS-total (β=4.19, 95% CI=2.81-5.58, p<0.001), particularly Hyperactivity (β=2.01, 95% CI=1.30-2.71, p<0.01) and Apathy (β=1.42, 95% CI=0.65-2.18, p<0.01) at baseline. Between baseline and year-2, multiple CMIs were associated with accelerated progression in NPS-total (β=0.29, 95% CI=0.06-0.53, p=0.015), driven by Hyperactivity (β=0.45, 95% CI=0.17-0.72, p<0.01). Subjects with multiple CMIs also had a faster functional decline, as measured with the CDR-sum-of-boxes scores, when accompanied with NPS-total progression (β=0.31, 95% CI=0.11-0.51, p<0.01), or Hyperactivity (β=0.34, 95% CI=0.13-0.56, p<0.01). Conclusion Cortical CMIs are associated with incidence and progression of geriatric neurobehavioral disturbances, independent of conventional SVD markers. The impact of incident CMIs on neurocognitive and neuropsychiatric trajectories warrants further investigations.

scholarly journals The Omega-3 Fatty Acid Eicosapentaenoic Acid (EPA) Correlates Inversely with Ischemic Brain Infarcts in Patients with Atrial Fibrillation

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 651
Author(s):  
Martin F. Reiner ◽  
Philipp Baumgartner ◽  
Andrea Wiencierz ◽  
Michael Coslovsky ◽  
Nicole R. Bonetti ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Fatty Acid ◽  
Small Vessel Disease ◽  
Small Vessel ◽  
Omega 3 ◽  
Total N ◽  
Ischemic Brain ◽  
Omega 3 Fatty Acid ◽  
Vessel Disease ◽  
Brain Infarcts

The omega-3 fatty acid (n-3 FA) eicosapentaenoic acid (EPA) reduces stroke in patients with atherosclerotic cardiovascular disease. Whether EPA affects stroke or cerebral small vessel dis-ease in patients with atrial fibrillation (AF) remains uncertain. EPA, docosahexaenoic acid (DHA), docosapentaenoic acid (DPA), and alpha-linolenic acid (ALA) were determined by gas chromatography in 1657 AF patients from the Swiss Atrial Fibrillation study. All patients underwent brain MRI to detect ischemic brain infarcts, classified as large noncortical or cortical infarcts (LNCCIs); markers of small vessel disease, classified as small noncortical infarcts (SNCIs), number of microbleeds, and white matter lesion (WML) volumes. Individual and total n-3 FAs (EPA + DHA + DPA + ALA) were correlated with LNCCIs and SNCIs using logistic regression, with numbers of microbleeds using a hurdle model, and WML volumes using linear regression. LNCCIs were detected in 372 patients (22.5%). EPA correlated inversely with the prevalence of LNCCIs (odds ratio [OR] 0.51 per increase of 1 percentage point EPA, 95% confidence interval [CI] 0.29–0.90). DPA correlated with a higher LNCCI prevalence (OR 2.48, 95%CI 1.49–4.13). No associations with LNCCIs were found for DHA, ALA, and total n-3 FAs. Neither individual nor total n-3 FAs correlated with markers of small vessel disease. In conclusion, EPA correlates inversely with the prevalence of ischemic brain infarcts, but not with markers of small vessel disease in patients with AF.

Differences of Ankle-Brachial Index according to Ischemic Stroke Subtypes: The Peripheral Artery Disease in Korean Patients with Ischemic Stroke (PIPE) Study

2013 ◽  
Vol 69 (3) ◽  
pp. 179-184 ◽  
Author(s):  
Pil-Wook Chung ◽  
Dae-Hyun Kim ◽  
Hahn Young Kim ◽  
Kwang-Yeol Park ◽  
Tai Hwan Park ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Peripheral Artery Disease ◽  
Ankle Brachial Index ◽  
Peripheral Artery ◽  
Korean Patients ◽  
Stroke Subtypes ◽  
Artery Disease

Abstract T P234: Multiparametric Assessment of Longitudinal Changes in Tissue Microstructure in Normal and Abnormal Brain Tissue in Patients with Small Vessel Disease

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Maria D Valdes-Hernandez ◽  
Paul A Armitage ◽  
Eleni Sakka ◽  
Susana Munoz Maniega ◽  
Natalie A Royle ◽  
...  
Keyword(s):  
White Matter ◽  
Brain Tissue ◽  
Small Vessel Disease ◽  
Brain Mri ◽  
Mean Diffusivity ◽  
Tissue Loss ◽  
Minor Stroke ◽  
Normal Brain ◽  
Limited Information ◽  
Time Points

Background: Volume measures of normal brain tissue and white matter hyperintensities (WMH) between two time points gives limited information about the complex dynamics of tissue change. We evaluated two quantitative parameters that characterise the microstructure of normal-appearing white matter (NAWM), deep grey matter (DGM) and WMH on brain images obtained at presentation with minor stroke and at 1 year to investigate the microstructural changes. Methods: From 182 brain MRI datasets of patients with minor stroke obtained at baseline and 1 year, we extracted the WMH, DGM and NAWM, and separated WMH into less-intense and intense WMH, using validated semi-automatic methods and validated criteria. We registered the binary structural masks to diffusion space and performed a voxel-wise subtraction of the combined masks at both time points. Then we measured fractional anisotropy (FA) and mean diffusivity (MD)(valuex10 -9 m 2 /s) in each tissue mask at baseline and 1 year. Results: WMH volume median increase was 1.4ml (IQR 6.98) mainly due to changes in less-intense WMH: 0.94ml (7.13). WMH that were visible at both time points, ie damage that remained after a year, had the lowest FA= 0.21(0.06) and highest MD=1.05(0.12) at baseline, and were mainly intense WMH at baseline (FA=0.12(0.03), MD=1.55(0.27)). WMH seen only at follow-up, ie that were NAWM at baseline, had the highest FA=0.30(0.06) and lowest MD=0.85 (0.06) at baseline. WMH that were observed only at baseline had intermediate FA=0.26(0.08) and MD=0.90(0.10). NAWM FA=0.26(0.03), MD=0.78(0.04) and DGM FA=0.23(0.03), MD=0.79(0.06) did not change between time points. Conclusions: WMH at baseline can partially evolve to normal-appearing tissues, remain or precede tissue loss. Differentiation between severe and subtle damage and spatial analysis are necessary to characterise the dynamic of WMH evolution.

Association of Bone Mineral Density to Cerebral Small Vessel Disease Burden

Neurology ◽  
2021 ◽  
Vol 96 (9) ◽  
pp. e1290-e1300
Author(s):  
Jeong-Min Kim ◽  
Kwang-Yeol Park ◽  
Hye Ryoun Kim ◽  
Hwa Young Ahn ◽  
Leonardo Pantoni ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Logistic Regression ◽  
Bone Mineral ◽  
Small Vessel Disease ◽  
Multinomial Logistic Regression ◽  
Brain Mri ◽  
Cerebral Small Vessel Disease ◽  
Mineral Density ◽  
Vessel Disease ◽  
Mineral Loss

ObjectiveTo test the hypothesis that bone mineral loss is mechanistically related to cerebral small vessel disease (SVD), we investigated the relationship between bone mineral density and the prevalence and intensity of SVD among patients with stroke.MethodsWe analyzed data of 1,190 consecutive patients with stroke who were >50 years of age and underwent both brain MRI and dual-energy x-ray absorptiometry from the stroke registry of Chung-Ang University Hospital in Seoul, Korea. The patients were categorized into 3 groups according to their bone mineral density (normal, osteopenia, and osteoporosis). White matter hyperintensities, silent lacunes, cerebral microbleeds, and extensive perivascular space were assessed from brain MRI. Multinomial logistic regression model was used to examine the association between osteoporosis and total SVD score. We also recruited 70 patients with stroke to study serum bone turnover markers and microRNAs related to both cerebral atherosclerosis and bone metabolism to understand bone and brain interaction.ResultsOsteoporosis was determined among 284 patients (23.9%), and 450 patients (37.8%) had osteopenia. As bone mineral density decreased, total SVD score and the incidence of every SVD phenotype increased except strictly lobar cerebral microbleeds. Multinomial logistic regression analysis showed that osteoporosis was independently associated with severe SVD burden. The levels of microRNA-378f were significantly increased among the patients with osteoporosis and maximal total SVD score and positively correlated with parathyroid hormone and osteocalcin.ConclusionsThese findings suggest a pathophysiologic link between bone mineral loss and hypertensive cerebral arteriolar degeneration, possibly mediated by circulating microRNA.

Sign in / Sign up

Export Citation Format

Share Document