Abstract
BackgroundEnlarged perivascular spaces (EPVS) correlate with cognitive impairment and incident dementia. However, etiologies for severe basal ganglia EPVS (BG-EPVS) are still unclear. Our aim was to investigate the independent risk factors for severe BG-EPVS in patients with acute lacunar stroke.MethodsWe prospectively identified patients with lacunar stroke (diameter on DWI ≤ 20mm) from Jan 2011 to May 2015. Patients with severe BG-EPVS were identified on T2 weighted MRI. Age (± 1 year) and sex matched controls were also recruited in the same population (two controls for one case). Vascular risk factors, clinical data, EPVS in centrum semiovale (rated 0 to 4), white matter hyperintensities (WMH) (by Fazekas scale), brain atrophy (rated 0 to 6) were compared between two groups. Logistic regression was performed to determine independent risk factors for severe BG-EPVS.ResultsDuring study period, 89 patients with severe BG-EPVS and 178 matched controls were included. Vascular risk factors did not differ between two groups. Patients with severe BG-EPVS had lower level of HbA1c and diastolic BP at admission, but presented with larger infarct size, more severe WMH (including total WMH, periventricular WMH and deep WMH) and brain atrophy. In logistic regression, brain atrophy (OR = 1.40; 95%CI 1.13, 1.73) and deep WMH (OR = 1.88; 95%CI 1.24, 2.83) were independent risk factors for severe BG-EPVS.ConclusionsBrain atrophy and deep WMH are independent risk factors for severe BG-EPVS, supporting the hypothesis that brain atrophy may be associated with the development of EPVS in basal ganglia.
Highlights
Enlarged perivascular spaces (EPVS), or Virchow Robin spaces, are common findings in elderly population with identical signal intensities to cerebral spinal fluid (CSF) in all MRI sequences. [1] EPVS are interstitial fluid filled cavities surrounding small penetrating arterioles and venules, serve as an important drainage conduit for interstitial fluid and solute in brain. [2] It has been identified that EPVS on MRI are a marker of small vessel disease (SVD) and associated with impaired cognitive function, incident dementia, depression and sleep. [3,4,5,6]EPVS often appear in centrum semiovale and basal ganglia
Brain atrophy and deep white matter hyperintensities (WMH) are independent risk factors for severe basal ganglia EPVS (BG-EPVS), supporting the hypothesis that brain atrophy may be associated with the development of EPVS in basal ganglia
Age, hypertension and white matter hyperintensities (WMH) had been identified as risk factors for EPVS in basal ganglia, [9] suggesting that EPVS in basal ganglia may be associated with hypertensive arteriopathy
Summary
Enlarged perivascular spaces (EPVS), or Virchow Robin spaces, are common findings in elderly population with identical signal intensities to cerebral spinal fluid (CSF) in all MRI sequences. [1] EPVS are interstitial fluid filled cavities surrounding small penetrating arterioles and venules, serve as an important drainage conduit for interstitial fluid and solute in brain. [2] It has been identified that EPVS on MRI are a marker of small vessel disease (SVD) and associated with impaired cognitive function, incident dementia, depression and sleep. [3,4,5,6]EPVS often appear in centrum semiovale and basal ganglia. The distribution patterns of EPVS in basal ganglia are in wide range, which can appear as a single enlarged space or as hundreds of bilateral. The latter pattern has been considered as severe basal ganglia EPVS (BG-EPVS). [7] The frequency of severe BG-EPVS in elderly population is low and their etiologies may be different from single EPVS in basal ganglia. Whether other risk factors, such as brain atrophy, contribute to severe BG-EPVS is still unknown. Enlarged perivascular spaces (EPVS) correlate with cognitive impairment and incident dementia. Our aim was to investigate the independent risk factors for severe BG-EPVS in patients with acute lacunar stroke
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