Abstract
To the Editor: We read with interest the recent paper by Yamamoto and colleagues1 evaluating longitudinal changes in MRI in patients with lacunar infarcts. The main conclusion reached by these authors is that high average ambulatory blood pressure, especially nighttime blood pressure, and a reduced nocturnal blood pressure dip may facilitate the development of silent ischemic lesions as well as symptomatic stroke recurrences in patients with lacunar infarcts. Before accepting these important conclusions, we believe that some comments are pertinent. We have also evaluated the effects of blood pressure in patients with first-ever lacunar infarcts and its association with the coexistence of silent lacunar infarcts2 and periventricular white matter intensities.3 Our main results suggest that both types of radiological signals react to separate hemodynamic mechanisms. Whereas silent lacunar infarcts seem to be related to elevated diurnal diastolic blood pressure, periventricular white matter intensities are better explained by elevated diurnal systolic blood pressure. A reduced heart rate, especially in lacunar infarct patients with a previous history of heart disease (symptoms of coronary heart disease, congestive heart failure, or electrocardiographic proof of ischemic changes or nonvalvular atrial fibrillation), is an additional factor associated with the severity of white matter abnormalities. It is likely that the angioarchitectural characteristics of the supplying vessels to the periventricular white matter explain why this region is vulnerable to different components of arterial blood pressure compared with the arterial territory of the lenticulostriate, thalamoperforant, or perforant branches of the basilar artery, where most silent lesions are located. …
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call