Frequency Of White Matter Lesions Research Articles

Cerebrovascular disorders in diabetic patients with resistant hypertension and factors associated with their severity

Abstract Introduction Diabetes mellitus (DM) and hypertension (HTN) are associated with accelerated brain damage that often precedes the development of stroke and dementia. However, little is known about the features of silent brain damages and possible mechanisms of their development in patients with resistant hypertension (RHTN) and type 2 DM. Objective To study the features of MRI- sings of silent brain damage in patients RHTN with type 2 DM and to establish the factors associated with their development. Methods We studied 46 with RHTN and type 2 DM (mean age 60.3±7.9 years; 27 females (59%), mean 24-hour (systolic/diastolic) BP 169.0±16.4/89.0±14.7 mmHg, HbA1c 7.4±1.3%). On average, patients were taking 4.3±1.0 antihypertensive drugs. Patients were subjected to brain MRI (1.5 T), 24-hour BP monitoring, lab tests (HbA1c, TNF-α, hsCRP, leptin, resistin, aldosterone, basal end postprandial serum glucose, insulin, C-peptide). According to MRI linear dimensions of liquor spaces (subarachnoidal spaces (SAS), lateral ventricles, III and IV ventricles), white matter lesions (WMLs), basal ganglia and thalamus abnormalities were assessed. In addition, severity of periventricular WMLs (PWMLs) was evaluated semi-quantitatively on a scale of 0 to 4. Results The frequency of ventricular dilatation was 45%, expansion of SAS – 65%, lacunar infarctions – 25%, focal WMLs (diameter <3 mm) – 52%, PWMLs – 89%. According to the correlation analysis, an increase in density of the MR signal of PWMLs was associated with an increase in levels of TNF-α (r=0.55 p=0.01) and hsCRP (r=0.64 p=0.045). The increase in density of the MR signal from basal ganglia and thalamus correlated with postprandial levels of glucose (r=0,48 p=0,025; r=0.46 p=0.04, respectively), insulin (r=0.54 p=0.011; r=0.52 p=0.017, respectively) and C-peptide (r=0.54 p=0.011; r=0.46 p=0.037, respectively), as well as with basal level of insulin (r=0.52 p=0.007; r=0.48 p=0.012, respectively) and the leptin (r=0.40 p=0.027; r=0.36 p=0.048, respectively). The severity of PWMLs depended on the level of basal glycaemia (r=0.35, p=0.020) and HbA1c (r=0.37, p=0.04). The transverse size of the chiasmal cistern had a relationship with of the resistin level (r=0.43, p=0.03), and the transverse size of the III ventricle correlated with the serum aldosterone level (r=0.51, p=0.13). There were no direct correlations between MRI- sings of silent brain damage and blood pressure levels. Conclusion Thus, diabetic patients with resistant hypertension have a high frequency of white matter lesions and of liquorodynamics dysturbanses. The severity of these changes depends on a complex of metabolic, pro-inflammatory and neurohormonal factors in the absence of a direct relationship with the blood pressure level. Funding Acknowledgement Type of funding sources: None.

MEFV gene mutations in neuro-Behçet's disease and neuro-Sweet disease.

Mediterranean fever (MEFV) gene mutations are associated with familial Mediterranean fever (FMF). Recent studies have suggested that MEFV gene mutations may act as disease modifiers in neuro‐Behçet's (NBD) disease and neuro‐Sweet disease (NSD). We investigated MEFV genes and clinical features in 17 patients with NBD or NSD. MEFV gene mutations were frequently observed (70.6%). Headaches and exertional leg pain were associated with MEFV gene mutations (P < 0.05). Moreover, higher frequency of white matter lesions without sites predilection (P < 0.05) and non‐parenchymal lesions (P < 0.05) were also observed. MEFV gene mutations may be associated with particular findings and lesion sites.

Exposure to surgery under general anaesthesia and brain magnetic resonance imaging changes in older adults

BackgroundPreclinical studies suggest that exposure to general anaesthesia (GA) could cause neurodegeneration consistent with Alzheimer's disease (AD) pathology. Brain magnetic resonance imaging (MRI) is useful to study structural brain changes. We tested the hypothesis that exposure to surgery with GA (surgery/GA) is associated with greater cortical thinning and increased frequency of white matter lesions. MethodsThis is a cross-sectional analysis of 70–91-yr-old participants enrolled in the Mayo Clinic Study of Aging who had baseline MRI. The thickness of selected cortical regions, the volume of white matter hyperintensities, and the frequency of cortical infarctions were compared in participants who were and were not exposed to surgery/GA within 20 yr before the first MRI obtained after enrolment. ResultsOf 1410 participants with MRI scans, 932 were exposed to surgery/GA before scanning. In adjusted analyses, cortical thickness in regions vulnerable to AD was significantly less in those exposed to surgery/GA in the prior 20 yr (difference −0.023 mm, [95% confidence interval (CI) −0.041 to −0.005], P=0.014). Those with surgery in the prior 20 yr were more likely to have ‘abnormal thickness’ compared with those without surgery (odds ratio=1.45, [95% CI 1.10–1.90], P=0.009). Exposure was not associated with white matter hyperintensities or the presence of brain infarcts. ConclusionsThis study suggests that exposure of older adults to surgical anaesthesia is associated with thinning in cortical regions implicated in AD. The pathogenesis and mechanisms driving these neurodegenerative changes, and the potential clinical significance of these findings, require further study.

P09.04 * CAROTID PLAQUE MRI AND STROKE AFTER RADIOTHERAPY: A LONG-TERM PROSPECTIVE COHORT STUDY

PURPOSE: Radiotherapy(RT) induced carotid artery vasculopathy and ischemic strokes are long-term complications after radiotherapy of the neck. The exact underlying pathofysiology of this RT induced atherosclerosis is not understood. The current study evaluated the presence and MRI characteristics of radiotherapy induced long-term carotid wall and cerebral complications in survivors of head and neck cancer (HNC). METHODS: Prospective multicenter long-term cohort study of 43 patients (mean age 60 years, SD 13) treated with RT of the neck because of head and neck cancer. Cerebrovascular risk factors were assessed at baseline (before RT). At follow-up (mean 7 years after RT) patients were evaluated with a MRA / MRI of the carotid arteries and the brain. First endpoint was frequency and characteristics (degree of stenosis, location, composition) of vessel wall changes. Secondary endpoints were frequency of white matter lesions, atrophy and (silent) brain infarctions. RESULTS: We found a vessel wall thickening in 55% of the irradiated common carotid arteries versus 18% in the non-irradiated. (p = 0.003). In the internal carotid arteries vessel wall thickening was found in 24% of the irradiated versus 6% of the non-irradiated arteries. (p = 0.02). Mean length of vessel wall thickening in the irradiated common and internal carotid arteries was 48.9 and 20 mm, respectively. In 50% of the irradiated common carotid arteries degree of stenosis was between 0 and 50%. MRI of the brain showed focal white matter lesions in 47% and mild atrophy in 33% of patients. CONCLUSION: Our study showed a significant increase in vessel wall changes on a long carotid segment in irradiated versus non-irradiated carotid arteries with a follow-up of 7 years after radiotherapy. An important proportion of patients also had intracranial vascular brain changes.

Incidence of cerebrovascular lesions in pure autonomic failure

In pure autonomic failure (PAF) - a rare form of primary dysautonomia - some patients show cerebrovascular lesions usually found in hypertensive subjects. In an autonomic laboratory records of patients with a definitive diagnosis of PAF having had cerebral imaging (cMRI, cCT) were analysed retrospectively. Tilt table data (supine/tilted), 24 hour blood pressure recordings (day/night) and serum catecholamine levels were correlated with cerebrovascular lesions and also compared to published normal values. 50 PAF patients (23 female, 27 male) were identified, mean age 67 years (sd 9.5). Out of these 35 (70%) had pathologic cerebral scans showing white matter lesions (WML) in 30, lacunar strokes in 5 and hemispheric stroke and microbleeds each in 1. Age and supine systolic blood pressure were significantly elevated in patients with pathologic scans (70 compared to 61 years [p=0.007], and 170 compared to 154 mmHg [p=0.045]). Out of 28 patients with WML and ambulatory blood pressure recordings available 24 were non-dippers. The data show that the frequency of WML is lower in PAF patients aged 60 to 80 years compared to age matched community based samples. Although PAF usually results in hypotension, a frequent complication is supine hypertension. Although the overall frequency of WML seems to be reduced in PAF, a number of patients with elevated supine systolic blood pressure (>160 mmHg) develop WML and some of these suffer stroke.

Gait disorders of unknown cause in the elderly: Clinical and MRI findings

Background Disequilibrium of unknown cause in older people has been associated with white matter lesions on neuroimaging studies. Objective To investigate the relationship between gait and balance problems in the elderly, white matter hyperintensities, and vascular risk factors. Methods We studied clinical and neuroimaging features in 30 people older than 65 years of age with gait disorders of unknown cause and 30 age- and sex-matched controls. Patients and controls underwent the same extensive quantitative test battery. White matter lesions on MRI scans were graded in different brain regions. Results History of hypertension was more common among patients than controls (60% vs. 27%, p = 0.012). On all scales, patients with gait disorders scored worse than controls. The frequency of white matter lesions was significantly higher in patients than in controls ( p < 0.001). In a multivariate logistic regression analysis in which diagnosis (patient vs. control) was the dependent variable, there was an association between diagnosis and white matter signal hyperintensity score ( p < 0.001) and history of hypertension ( p = 0.039). Conclusions Gait disorders of unknown cause in older people are associated both with white matter lesions on MRI scans and with history of hypertension.

Psychomotor slowing in older patients with major depression: Relationships with blood flow in the caudate nucleus and white matter lesions

Objectives Selected structural and functional neuroimaging correlates of psychomotor slowing were examine in older persons with depression. Clinical, neuropsychological, magnetic resonance imaging (MRI) and single photon emission computerized tomography (SPECT) data were obtained for 32 persons with depression (mean age = 55.5) and 17 controls (mean age = 55.4). Psychomotor slowing was measured by simple (SRT) and choice (CRT) reaction times. White matter lesions (WMLs) were visually rated and caudate nucleus regional cerebral blood flow (rCBF) was obtained through the co-registration of MRI and SPECT data. Two SPECT scans were performed (corresponding to the SRT and CRT tasks) and a percentage change score in rCBF (%rCBF) due to the increasing complexity of the second task was calculated. Persons with depression and controls did not differ with respect to %rCBF or frequency of WMLs. In persons with depression, reduced %rCBF was associated with slower CRT. For all subjects, WMLs predicted 14% of the variance in %rCBF. Although CRT was predicted by a combination of older age, WMLs and %rCBF, the diagnosis of depression still predicted a further 25% of the variance. Reduced %rCBF is associated with demonstrable psychomotor slowing and presence of WMLs. While psychomotor slowing is determined in part by subcortical changes, other cortical and illness-dependent factors are likely to be relevant.

Increased frequency of white matter lesions in patients with osteonecrosis (WMLeOn) of the femoral head

White matter lesions (WML) are commonly seen in cerebral MR imaging in normal and demented elderly people or young people suffering from migraine. We present data showing that WML are detected in an unexpectedly high frequency (56.9%) in patients with non-traumatic osteonecrosis of the femoral head compared to age and sex-matched controls. We designated the coexistence of WML and osteonecrosis as white matter lesions in osteonecrosis (WMLeON). We examined the possible association of WMLeON with hyperlipidaemia and other risk factors for WML or osteonecrosis of the femoral head. The frequency of history of corticosteroid treatment was statistically lower in patients with WMLeON (58.6%) compared to those without it (90.1%) ( P=0.03). We found no association of WMLeON with diabetes, stroke, hyperlipidaemia, migraine, smoking, alcohol consumption, hypertension, atrial fibrillation, or systemic lupus erythematosus. Although, the clinical significance of WMLeON is still unknown, this finding supports, at least, the hypothesis that non-traumatic osteonecrosis is indeed a multisystem disorder rather than a disease of human skeleton.

Frequency of white matter lesions and silent lacunar infarcts.

White matter lesions and silent lacunar infarcts are related to and may result from cerebral small vessel disease. Reported frequencies of these lesions vary largely among studies. Differences in imaging techniques, rating scales, cut-off points in lesion severity grading and study populations contribute to the variation, in addition to differences in risk factor profiles across studies. In this paper, we will firstly discuss general methodological issues that may influence reported frequencies of white matter lesions and silent lacunar infarctions, and then review published data. We will focus on the results from population-based studies and only briefly comment on patient series of stroke and dementia.

Comparison between Multiple Lacunar Infarcted Patients with and without Dementia in Nursing Homes in Shimane Prefecture, Japan

We evaluated the activity of daily living (ADL) scores, the frequency of hypertension (HT) and diabetes mellitus (DM), and the frequency and distribution of white matter lesions in a vascular dementia group with multiple lacunar infarctions (VD group; 20 cases) and a nondemented group with multiple lacunar infarctions (non-D group; 32 cases), relative to a normal control group (29 cases). There were no significant differences in HT and DM among the three groups. ADL scores were significantly lower in the VD than in the non-D group, each of which was lower than in the control group. Frequency of white matter lesions (Binswanger’s disease-like lesions in the frontal and parietal lobes) was significantly higher in the VD than in the non-D group, which was higher than in the control group. We believe that for dementia with multiple lacunar infarctions, diffusely affected cerebrum including white matter lesions, which results in low ADL scores for symptoms, may be a prerequisite.

Cognitive dysfunctions and white matter lesions in patients with bipolar disorder in remission

To compare cognitive functioning in relation to white matter lesions in bipolar disorder in remission and schizophrenia. Cognitive performance and the occurrence of white matter lesions on MRI images of the brain were assessed in 22 patients with bipolar disorder in remission, 22 patients with schizophrenia and 22 healthy volunteers. Performance of tests of memory, speed and cognitive flexibility was significantly impaired in both patient groups. The frequency of white matter lesions did not differ significantly between the three groups. No differences in cognitive performance were found between patients with white matter lesions and patients without such lesions. White matter lesions apparently do not underlie cognitive deficits that are found in patients with bipolar disorder in remission and in patients with schizophrenia.

Disequilibrium in older people: a prospective study.

To identify the clinical and neuroimaging features in older people with disequilibrium of unknown cause. Many older people show a deterioration of balance without an identifiable cause. Whether the disequilibrium is a normal aging phenomenon, the result of yet unidentified neuropathology, or a combination of the two is unknown. Twenty-nine patients who complained of disequilibrium (ages 75 to 92) and 29 age- and sex-matched control subjects completed five yearly examinations including history and semiquantitative neurologic examination, activities of daily living, visual acuity, mini-mental status, bedside gait and balance score (Tinetti), Purdue pegboard, and vestibular function testing. Concerns about falling and number of falls were quantified. Subcortical white matter lesions (WML) and frontal atrophy (FA) were graded (blindly), and the ventricular-brain ratio (VBR) was measured from MRIs of the brain. On entry, patients differed from control subjects only in measures of balance, concerns about falling, and falls. Over the 5 years, patients were four times more likely to fall than control subjects. The number of falls was highly correlated with measures of balance (p < 0.001). The VBR as well as the frequency of WML and FA were all significantly (p < 0.001) greater in patients than in control subjects. Disequilibrium of unknown cause in older people is associated with frequent falls, concerns about falling, brain atrophy, and WML on MRI. Some cases are probably caused by small-vessel ischemic disease.

Chronic progressive spinocerebellar syndrome associated with antibodies to human T-lymphotropic virus type I: clinico-virological and magnetic resonance imaging studies

The relationship between HTLV-I infection and the development of spinocerebellar degeneration (SCD) in adulthood was studied. The frequency of anti-HTLV-I antibodies among patients with SCD (8 of 43, 19%) was found to be higher than the seroprevalence rate in the northern part of Kyushu island (6%). All HTLV-I carriers with SCD showed chronic progressive cerebellar ataxia as a predominant feature and cerebellar atrophy was evident in 6 of 8 patients on magnetic resonance imaging (MRI) of the brain. However, SCD patients with anti-HTLV-I antibodies showed a significantly higher frequency of cerebral white matter lesions on brain MRI (6 of 8) and pyramidal tract signs in lower extremities (6 of 8) than did those without the antibodies (35%, P < 0.05 and 26%, P < 0.01, respectively). Moreover, the HTLV-I carriers with SCD exceeded 14 HTLV-I carriers having neither SCD nor HTLV-I-associated myelopathy (HAM)/tropical spastic paraparesis (TSP) (21%, P < 0.05), and 59 HTLV-I seronegative patients without brain disorders (19%, P < 0.001) in the frequency of white matter lesions. On the other hand, the HTLV-I carriers with SCD were distinct to the HAM/TSP patients in the predominance of cerebellar involvement. Therefore, the peculiar features of cerebellar, pyramidal and white matter involvement in the HTLV-I-seropostive SCD patients as well as the increased frequency of HTLV-I infection among SCD patients suggest that this syndrome may be a distinct subtype of HTLV-I-associated neurologic diseases.