Abstract
IntroductionIt 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 methodsWe 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.ResultsWe 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.DiscussionAlthough 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.ConclusionThere are differences between MRI markers of SVD between patients with a lacunar stroke and those with a non-lobar ICH.
Highlights
It is unclear why cerebral small vessel disease (SVD) leads to lacunar stroke in some and to non–lobar intracerebral hemorrhage (ICH) in others
Periventricular white matter hyperintensities (WMH) burden has been associated with a lacunar stroke, whereas presence of cerebral microbleeds (CMB) was associated with a non–lobar ICH.[7]
We investigated associations of SVD magnetic resonance imaging (MRI) markers with either of the two stroke types using an age– and sex adjusted multivariable logistic regression model including vascular risk factors that were significant in univariate tests
Summary
It is unclear why cerebral small vessel disease (SVD) leads to lacunar stroke in some and to non–lobar intracerebral hemorrhage (ICH) in others. Consequences of SVD can be visualized by its markers on magnetic resonance imaging (MRI), including white matter hyperintensities (WMH), lacunes, and cerebral microbleeds (CMB).[6] Previously, periventricular WMH burden has been associated with a lacunar stroke, whereas presence of CMB was associated with a non–lobar ICH.[7] This study, did not investigate differences in spatial distribution patterns of SVD markers on MRI between groups, which could be essential for understanding the clinical course of SVD. Our results may potentially identify MRI markers of SVD that differentially predispose to either ischemia or hemorrhage, that in time may have implications for secondary preventive treatment
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