scholarly journals Imaging markers of small vessel disease and brain frailty, and outcomes in acute stroke

Neurology ◽  
2019 ◽  
Vol 94 (5) ◽  
pp. e439-e452 ◽  
Author(s):  
Jason P. Appleton ◽  
Lisa J. Woodhouse ◽  
Alessandro Adami ◽  
Jennifer L. Becker ◽  
Eivind Berge ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Clinical Decision Making ◽  
Small Vessel Disease ◽  
Small Vessel ◽  
Vascular Lesions ◽  
Imaging Features ◽  
Lacunar Stroke ◽  
Vessel Disease ◽  
Imaging Markers ◽  
Frailty Score

ObjectiveTo assess the association of baseline imaging markers of cerebral small vessel disease (SVD) and brain frailty with clinical outcome after acute stroke in the Efficacy of Nitric Oxide in Stroke (ENOS) trial.MethodsENOS randomized 4,011 patients with acute stroke (<48 hours of onset) to transdermal glyceryl trinitrate (GTN) or no GTN for 7 days. The primary outcome was functional outcome (modified Rankin Scale [mRS] score) at day 90. Cognition was assessed via telephone at day 90. Stroke syndrome was classified with the Oxfordshire Community Stroke Project classification. Brain imaging was adjudicated masked to clinical information and treatment and assessed SVD (leukoaraiosis, old lacunar infarcts/lacunes, atrophy) and brain frailty (leukoaraiosis, atrophy, old vascular lesions/infarcts). Analyses used ordinal logistic regression adjusted for prognostic variables.ResultsIn all participants and those with lacunar syndrome (LACS; 1,397, 34.8%), baseline CT imaging features of SVD and brain frailty were common and independently associated with unfavorable shifts in mRS score at day 90 (all participants: SVD score odds ratio [OR] 1.15, 95% confidence interval [CI] 1.07–1.24; brain frailty score OR 1.25, 95% CI 1.17–1.34; those with LACS: SVD score OR 1.30, 95% CI 1.15–1.47, brain frailty score OR 1.28, 95% CI 1.14–1.44). Brain frailty was associated with worse cognitive scores at 90 days in all participants and in those with LACS.ConclusionsBaseline imaging features of SVD and brain frailty were common in lacunar stroke and all stroke, predicted worse prognosis after all acute stroke with a stronger effect in lacunar stroke, and may aid future clinical decision-making.IdentifierISRCTN99414122.

scholarly journals Differences in cerebral small vessel disease magnetic resonance imaging markers between lacunar stroke and non–Lobar intracerebral hemorrhage

2021 ◽  
pp. 239698732110317
Author(s):  
Kim Wiegertjes ◽  
Michelle G Jansen ◽  
Wilmar MT Jolink ◽  
Marco Duering ◽  
Emma A Koemans ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Multivariable Logistic Regression Analysis ◽  
Lacunar Stroke ◽  
Vessel Disease ◽  
Different Types ◽  
Imaging Markers ◽  
Lesion Symptom Mapping

Introduction It is unclear why cerebral small vessel disease (SVD) leads to lacunar stroke in some and to non–lobar intracerebral hemorrhage (ICH) in others. We investigated differences in MRI markers of SVD in patients with lacunar stroke or non–lobar ICH. Patients and methods We included patients from two prospective cohort studies with either lacunar stroke (RUN DMC) or non–lobar ICH (FETCH). Differences in SVD markers (white matter hyperintensities [WMH], lacunes, cerebral microbleeds [CMB]) between groups were investigated with univariable tests; multivariable logistic regression analysis, adjusted for age, sex, and vascular risk factors; spatial correlation analysis and voxel–wise lesion symptom mapping. Results We included 82 patients with lacunar stroke (median age 63, IQR 57–72) and 54 with non-lobar ICH (66, 59–75). WMH volumes and distribution were not different between groups. Lacunes were more frequent in patients with a lacunar stroke (44% vs. 17%, adjusted odds ratio [aOR] 5.69, 95% CI [1.66–22.75]) compared to patients with a non–lobar ICH. CMB were more frequent in patients with a non–lobar ICH (71% vs. 23%, aOR for lacunar stroke vs non–lobar ICH 0.08 95% CI [0.02–0.26]), and more often located in non–lobar regions compared to CMB in lacunar stroke. Discussion Although we obserd different types of MRI markers of SVD within the same patient, ischemic markers of SVD were more frequent in the ischemic type of lacunar stroke, and hemorrhagic markers were more prevalent in the hemorrhagic phenotype of non-lobar ICH. Conclusion There are differences between MRI markers of SVD between patients with a lacunar stroke and those with a non-lobar ICH.

scholarly journals Non breathing-related sleep fragmentation and imaging markers in patients with atherosclerotic cerebral small vessel disease (CSVD), a cross-sectional case-control study

2019 ◽  
Author(s):  
Jihui Wang ◽  
Xiaodong Chen ◽  
Jinchi Liao ◽  
Li Zhou ◽  
Hongying Han ◽  
...  
Keyword(s):  
Small Vessel Disease ◽  
Sleep Onset ◽  
Cerebral Small Vessel Disease ◽  
Sleep Fragmentation ◽  
Small Vessel ◽  
Arousal Index ◽  
Vessel Disease ◽  
Imaging Markers ◽  
The Relationship ◽  
Normal Controls

Abstract Objective Evidence of a relationship between non breathing-related sleep fragmentation and imaging markers of the brain in cerebral small vessel disease (CSVD) patients is scarce. The purpose of the present study was to investigate the relationship in CSVD patients living in China, where CSVD is a major pathogenesis underlying stroke. Methods A group of 84 CSVD patients were prospectively recruited along with 24 age and sex matched normal controls. 3.0 T superconducting magnetic resonance imaging and overnight polysomnography were conducted in all the participants. Polysomnography parameters including sleep onset latency, total sleep time; sleep efficiency, wake after sleep onset, percentage of each sleep stage (N1, N2, N3 and REM) and arousal index were compared between the CSVD patients and normal controls, and the relationship between arousal index and CSVD markers was explored in the CSVD group. Results Polysomnography measures showed that CSVD patients had significantly higher arousal index and wake after sleep onset, lower sleep efficiency and N-3 ratio compared to normal controls ( p < 0.05). The results of ordinal logistic regression showed that higher arousal index was positively associated with the severity of periventricular white matter hyperintensity (OR 1.177, 95% CI 0.170 to 2.295) and perivascular space (OR 1.245, 95% CI 0.485 to 2.124) in CSVD patients, after adjusting for all the independent variables. Conclusions These preliminary results indicate that non breathing-related sleep fragmentation is common and related to the pathological markers of CSVD patients. Future prospective research is invited to establish the causal relationship between sleep parameters and CSVD pathology.

Small vessel disease

2020 ◽  
pp. 203-212
Author(s):  
Fergus N Doubal ◽  
Anna Poggesi ◽  
Leonardo Pantoni ◽  
Joanna M Wardlaw
Keyword(s):  
Small Vessel Disease ◽  
Current Knowledge ◽  
Intrinsic Disorder ◽  
Small Vessel ◽  
Imaging Features ◽  
World Region ◽  
Vessel Disease ◽  
Cerebral Arterioles ◽  
The Brain ◽  
Review Current

‘Small vessel disease’ describes a combination of neuroradiological and clinical features that are due to an intrinsic disorder of the small cerebral arterioles, capillaries, and venules in varying proportions. It is very common, usually sporadic, although rare monogenic forms are well described. The commonest presentations are with stroke or cognitive impairment. The cause of the small vessel abnormalities in the sporadic form is not well understood and the brain damage is generally attributed to ischaemia secondary to the vessel abnormality. However, evidence for altered microvessel function and blood brain barrier failure is accumulating. The commonest risk factors are increasing age, hypertension, smoking, and diabetes, but environmental and lifestyle factors are also important although poorly understood. Whether the imaging features or incidence of small vessel-related stroke or dementia vary by world region is unknown. We review current knowledge on presentation, aetiology, incidence, and prevalence of sporadic small vessel disease.

Ischaemic stroke: common causes

2017 ◽  
Author(s):  
Hugh Markus ◽  
Anthony Pereira ◽  
Geoffrey Cloud
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Ischaemic Stroke ◽  
Small Vessel Disease ◽  
Small Vessel ◽  
Large Artery ◽  
Lacunar Stroke ◽  
Vessel Disease ◽  
Common Causes ◽  
Artery Disease

This chapter on common causes of ischaemic stroke reviews the major pathologies underlying ischaemic stroke, namely large-artery disease, cardioembolism, and small-vessel disease. Large-vessel extra- and intracranial atherosclerotic cerebrovascular disease is covered. Cardioembolic aetiologies of stroke including atrial fibrillation and valvular heart disease are discussed. Small-vessel disease causing lacunar stroke and possible heterogonous pathologies underlying this subtype are covered. Dolichoectasia of arteries as a potential cause of stroke and the newer concept of embolic stroke of undetermined source are also discussed.

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