Association between white matter hyperintensities and stroke in a West African patient population: Evidence from the Stroke Investigative Research and Educational Network study

Abstract

BackgroundThis study is part of the Stroke Investigative Research and Educational Network (SIREN), the largest study of stroke patients in Africa to date, with computed tomography (CT) or magnetic resonance (MR) imaging data for each patient to confirm stroke. Prior imaging studies performed using high-field MR (≥1.5T) have shown that white matter hyperintensities (WMH), signs of microangiopathy in the subcortical brain, are correlated with many stroke risk factors as well as poor stroke outcomes. The aim of this study was the evaluation of MR images (0.3T–1.5T) from the SIREN study to determine associations between WMH volumes in West African patients and both stroke outcomes and stroke risk factors identified in the SIREN study. Materials and methodsBrain MR images of 130 Western African stroke patients (age ​= ​57.87 ​± ​14.22) were processed through Lesion Segmentation Toolbox of the Statistical Parametric Mapping software to extract all areas of hyperintensity in the brain. WMH was separated from stroke lesion hyperintensity and WMH volume was computed and summed. A stepwise linear regression and multivariate analysis was performed between patients’ WMH volume and sociodemographic and clinical indices. ResultsMultivariate analysis showed that high WMH volume was statistically significantly positively correlated with age (β ​= ​0.44, p ​= ​0.001), waist/hip ratio (β ​= ​0.22, p ​= ​0.03), and platelet count (β ​= ​0.19, p ​= ​0.04) after controlling for head size in a Western African stroke population. ConclusionAssociations between WMH and age and waist/hip ratio previously identified in Western countries were demonstrated for the first time in a resource-limited, homogeneous black African community using low-field MR scanners.