Abstract
Background and aimsEnlarged perivascular spaces (also known as Virchow–Robin spaces) on T2-weighted brain magnetic resonance imaging are common, but their etiology, and specificity to small vessel as opposed to general cerebrovascular disease or ageing, is unclear. We tested the association between enlarged perivascular spaces and ischemic stroke subtype, other markers of small vessel disease, and common vascular risk factors.MethodsWe prospectively recruited patients with acute stroke, diagnosed and subtyped by a stroke physician using clinical features and brain magnetic resonance imaging. A neuroradiologist rated basal ganglia and centrum semiovale enlarged perivascular spaces on a five-point scale, white matter lesions, recent and old infarcts, and cerebral atrophy. We assessed associations between basal ganglia-, centrum semiovale- and total (combined basal ganglia and centrum semiovale) enlarged perivascular spaces, stroke subtype, white matter lesions, atrophy, and vascular risk factors.ResultsAmong 298 patients (mean age 68 years), after adjusting for vascular risk factors and white matter lesions, basal ganglia–enlarged perivascular spaces were associated with increasing age (P = 0·001), centrum semiovale–enlarged perivascular spaces (P < 0·001), cerebral atrophy (P = 0·03), and lacunar stroke subtype (P = 0·04). Centrum semiovale–enlarged perivascular spaces were associated mainly with basal ganglia–enlarged perivascular spaces. Total enlarged perivascular spaces were associated with increasing age (P = 0·01), deep white matter lesions (P = 0·005), and previous stroke (P = 0·006).ConclusionsEnlarged perivascular spaces are associated with age, lacunar stroke subtype and white matter lesions and should be considered as another magnetic resonance imaging marker of cerebral small vessel disease. Further evaluation of enlarged perivascular spaces in studies of ageing, stroke, and dementia is needed to determine their pathophysiological importance.
Highlights
Perivascular spaces surround perforating arterioles and venules as they course from the subarachnoid space through the brain parenchyma [1]
We further examined associations between EPVS, White matter lesions (WMLs), and stroke subtype in patients with different types of ischemic stroke, adjusting for vascular risk factors, to determine if there was a specific association between EPVS and small vessel disease (SVD)
Among the 1311 acute ischemic stroke patients recruited to the Edinburgh Stroke Study, 313 underwent brain magnetic resonance imaging (MRI)
Summary
Perivascular spaces surround perforating arterioles and venules as they course from the subarachnoid space through the brain parenchyma [1] They are an important drainage conduit for cerebral interstitial fluid [2,3]. Until recently regarded as normal, of no clinical consequence, and ignored in many studies of stroke, leukoaraiosis, and ageing, EPVS vary considerably in number between individuals and when numerous, are probably not normal. We tested the association between enlarged perivascular spaces and ischemic stroke subtype, other markers of small vessel disease, and common vascular risk factors
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