Abstract
In cross-sectional studies periventricular white matter lesions (WML) were related to low plasma levels of vitamin B12. Whether low vitamin B12 levels are also related to progression of WML is still unknown. We studied baseline vitamin B12 levels and its association with progression of WML over 2 years of follow-up in first-ever lacunar stroke patients. In 107 first-ever lacunar stroke patients in whom baseline brain MRI and vitamin B12 status were available, we obtained a follow-up brain MRI after 2 years. We assessed progression of periventricular WML (pWML) and deep WML (dWML) using a visual WML change scale. We studied the relationship between baseline levels of plasma vitamin B12 and progression of WML after 2 years of follow-up by binary logistic regression analyses. Vitamin B12 deficiency was more frequent in patients with progression of pWML compared to those without progression (41.9% and 19.7% respectively, p = 0.02). Corrected for sex and age, progression of pWML was associated with lower baseline levels of vitamin B12 (OR 1.42 per 50 unit decrease, 95% CI 1.00-1.92). Vitamin B12 levels were not associated with progression of dWML. In conclusion progression of pWML after 2 years of follow-up relates to low levels of vitamin B12 at baseline in first-ever lacunar stroke patients. Whether this population could benefit from vitamin B12 supplementation is unknown and requires further investigation.
Highlights
Lacunar infarcts and white matter lesions (WML) are common features of cerebral small vessel disease [1,2]
In a cross-sectional population-based study vitamin B12 status was associated with severity of periventricular WML and, to a lesser extent, with deep WML [6]
We found periventricular WML (pWML) to be related to low vitamin B12 levels in patients with small vessel stroke [7]
Summary
Lacunar infarcts and white matter lesions (WML) are common features of cerebral small vessel disease (cSVD) [1,2]. Derangement of the blood-brain barrier is thought to be an important underlying initiating cause of cSVD [1,2]. One of the factors that may play a role in maintaining the integrity of the blood-brain barrier is vitamin B12 [3,4,5]. In a cross-sectional population-based study vitamin B12 status was associated with severity of periventricular WML (pWML) and, to a lesser extent, with deep WML (dWML) [6]. We found pWML to be related to low vitamin B12 levels in patients with small vessel (i.e. lacunar) stroke [7]. Progression of WML is associated with gait abnormalities, cognitive impairment and urinary disturbances, and it could be important to identify associated factors that may be treatable [8,9]
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