Incidence Of White Matter Lesions Research Articles

The Influence of Patent Foramen Ovale on the Clinical Features of Migraine without Aura: A Cross-Sectional Study.

To investigate the influence of patent foramen ovale (PFO) on the clinical features of migraine without aura (MoA). We consecutively enrolled 390 MoA patients and compared the frequency of headache, episode duration, and the Visual Analogue Scale (VAS), Headache Impact Test 6 (HIT-6), and European Health Interview Survey-Quality of Life 8-item index (EUROHIS-QOL8) scores of patients with and without PFO, those with the mild right-to-left shunt (RLS) and moderate to large RLS, and those with permanent RLS and latent RLS using a nonparametric Mann-Whitney U-test. In addition, we analyzed the clinical features of migraine in 39 MoA patients before and after PFO closure treatment using the paired Wilcoxon test. The prevalence of PFO in the 390 MoA patients was 44.4%. Patients with PFO had significantly higher frequency of headaches, VAS scores, HIT-6 scores, and incidence of white matter lesions than those without PFO (all p< 0.05). Patients with moderate to large RLS had significantly higher VAS scores than those with mild RLS (p = 0.002). Additionally, 39 MoA patients underwent PFO closure, which remarkably decreased their frequency of headache, episode duration, VAS scores, and HIT-6 scores, and increased their EUROHIS-QOL8 scores. The migraine features in MoA patients could be influenced by PFO, especially in patients with moderate to large shunt, in whom PFO closure improved the symptoms.

Nomograms for predicting the incidence of white matter lesions: a real-world study based on elderly patients.

Nowadays, there are still some doubts about the etiology, development, and preventive measures of white matter lesions. This research collected patient information in the Dryad Digital Repository database to identify predictors of patients with white matter lesions. We studied patients who underwent head MRI and blood tests during comprehensive physical examinations at Shin Takeo Hospital, Japan, between April 1, 2016, and October 30, 2017. We screened patients over the age of 60 and investigated white risk factors in material lesions in older patients and, randomly assigning patients to training and validation groups, we built nomograms on the basis of the training group and used other group data to verify its accuracy and consistency. A total of 854 patients were included in this study. Multivariate analysis was performed according to the data before randomization, and the results showed that the age of patients (OR=2.81, 95% CI: 1.74-4.54), high-density lipoprotein (OR=1.31, 95% CI: 1.02-1.68), diastolic blood pressure (OR=1.47, 95% CI: 1.04-2.08). Taking antihypertensive drugs (OR=1.78, 95% CI: 1.21-2.66) was significantly associated with white matter lesions. The area under the curve value (AUC) was 0.625 for the training group and 0.729 for the validation group. The clinical impact curve and calibration curve show that the model has good accuracy and clinical application value. Age, high-density lipoprotein (HDL), diastolic blood pressure (DBP), and the use of antihypertensive drugs are closely related to white matter lesions. Furthermore, our model may be a useful tool for predicting the incidence of white matter lesions.

The association between white matter lesions and carotid plaque score: a retrospective study based on real-world populations.

To date, more and more studies have focused on the occurrence and development of white matter lesions. Instead, we explored the association between the occurrence of white matter lesions and carotid plaque scores in different populations. We studied patients who underwent head MRI and blood tests from April 1, 2016 to October 30, 2017 at Shin Takeo Hospital, Japan. We used multiple logistic regression analysis to analyze the relationship between the occurrence of white matter lesions and carotid plaque score and validated their relationship in three different models. A total of 1,904 patients aged 20-85 years were included in this study. There were 860 patients in the non-white matter lesion group and 1,044 patients in the white matter lesion group. The mean age of patients in the non-white matter lesion group was 49.93±10.76 years, and in the white matter lesion group was 61.60±9.15 years. We established multiple regression analyses for white matter lesion and carotid plaque scores and found that the risk of white matter lesions increased with increasing carotid plaque score. (Model 1 (OR (95% CI): 1.360 (1.276, 1.450), Model 2 (OR (95% CI): 1.122 (1.048, 1.200), Model 3 [OR (95% CI): 1.106 (1.032, 1.186)]. Our study found that the incidence of white matter lesions tended to increase with increasing carotid plaque scores, a trend that was more pronounced in younger female patients but was not so pronounced in older male patients.

Incidence of white matter lesions in hospitalized COVID-19 patients: A meta-analysis.

ObjectiveNovel coronavirus disease 2019 (COVID‐19) has been found to be associated with encephalopathy and brain imaging abnormalities. The identification of incident white matter lesions, known to be associated with cerebral microcirculatory failure and cerebrovascular disease, in COVID‐19 patients is of clinical and scientific interest. We performed a meta‐analysis to investigate the incidence of white matter lesions (WMLs) in hospitalized COVID‐19 patients.MethodsPubMed, EMBASE, and the Cochrane Library were searched for studies on brain imaging abnormalities in hospitalized COVID‐19 patients. The terms used included “white matter lesions,” “white matter hyperintensity,” “COVID‐19,” “coronavirus,” and “SARS‐CoV‐2.” A random‐effects meta‐analysis was conducted to obtain a pooled estimate of WML prevalence in hospitalized COVID‐19 patients.ResultsA total of 4 eligible studies involving 362 patients (144 with WMLs and 218 without) were included in the meta‐analysis. We found the pooled estimate of WML prevalence to be 20% (ES 0.20; 95% CI 0.00–0.54; p = .03).ConclusionsThe estimated pooled prevalence rate of WMLs was approximately 20% in hospitalized COVID‐19 patients, albeit lower than the crude prevalence rate (39.8%).

An Assessment of the Relationship between Structural and Functional Imaging of Cerebrovascular Disease and Cognition-Related Fibers.

In order to assess the relationship between structural and functional imaging of cerebrovascular disease and cognition-related fibers, this paper chooses a total of 120 patients who underwent cerebral small vessel disease (CSVD) treatment at a designated hospital by this study from June 2013 to June 2018 and divides them into 3 groups according to the random number table method: vascular dementia (VaD) group, vascular cognitive impairment no dementia (VCIND) group, and noncognition impairment (NCI) group with 40 cases of patients in each group. Cognitive function measurement and imaging examination were performed for these 3 groups of patients, and the observation indicators of cognitive state examination (CSE), mental assessment scale (MAS), clock drawing test (CDT), adult intelligence scale (AIS), frontal assessment battery (FAB), verbal fluency test (VFT), trail making test (TMT), cognitive index (CI), white matter lesions (WML), third ventricle width (TVW), and frontal horn index (FHI) were tested, respectively. The results shows that the average scores of CSE, MAS, AIS, and VFT in the VaD and VCIND group are lower than those of the NCI group and the differences are statistically significant (P < 0.05); the average scores of FAB, TMT, and CI in the VaD group are higher than those of the VCIND group and the differences are also statistically significant (P < 0.05); the average scores of FHI and TVW in the VaD group are lower than those of the VCIND and NCI group with statistically significant differences (P < 0.05); the average scores of WML, CDT, and AIS in the VaD group are higher than those of the VCIND and NCI group with statistically significant differences (P < 0.05). Therefore, it is believed that the structural and functional imaging features of cerebrovascular disease are closely related to cognition-related fibers, and the incidence of white matter lesions is closely related to the degree of lesions and cognitive dysfunction of cerebral small vessel disease, in which a major risk factor for cognitive dysfunction in patients with small blood vessels is the severity of white matter lesions; brain imaging and neuropsychiatric function assessment can better understand the relationship between cerebrovascular disease and cognitive impairment. The results of this study provide a reference for the further research studies on the relationship between structural and functional imaging of cerebrovascular disease and cognition-related fibers.

White matter lesions and sudden sensorineural hearing loss

Aim of this paper is to investigate the presence of White Matter Lesions (WMLs) in subjects affected by Sudden Sensorineural Hearing Loss (SSNHL) and possibly to evaluate the significance of WMLs in SSNHL patients.A total of 64 patients (cases) affected by SSNHL were included in this case-control study. Hearing tests were performed at SSNHL onset, after 7 days and after 30 days. Cerebral MRI sequences were performed to rule out retrocochlear pathology, and WMLs were evaluated if present. MRI control group included 32 subjects, without hearing loss, affected by pituitary adenoma, who underwent cerebral MRI of follow-up.WML presence in those affected by SSNHL resulted having a similar distribution to that of the control group; however, we observed complete hearing recovery in 42,9% of patients without WML and in 11,6% of patients with WML >1 (p = 0,017*).The incidence of WML in patients with SSNHL was not different compared to that of the control group; however, MRI could have a prognostic role for SSNHL patients, as the presence of WMLs can been linked to a poorer hearing recovery rate.

34 Decreased dilation of hippocampal arterioles in a rat model of preeclampsia

Introduction Women with preeclampsia (PE) and eclampsia have increased incidence of white matter lesions in the brain and self-report cognitive impairment later in life, suggesting seizures during PE may lead to long-lasting brain injury. The hippocampus, a brain region central to cognition, is more susceptible to seizure-induced injury due to less effective functional hyperemia. How PE affects the function and structure of the hippocampal vasculature remains unknown, but could further limit functional hyperemia and potentiate seizure-induced injury. Objective We tested the hypothesis that hippocampal arterioles (HpAs) in PE have impaired responses to mediators of dilation generated during seizure including extracellular potassium (K+) and nitric oxide (NO) and undergo inward remodeling that limits blood flow to the hippocampus during seizure. Methods Sprague Dawley rats were nonpregnant (NP; n = 6), pregnant (P; d20; n = 6) or with PE (induced by a high cholesterol diet gestational days 7–20; n = 6). HpAs were isolated and pressurized to 60 mmHg in an arteriograph chamber. The function of HpAs was investigated by measuring changes in lumen diameter in response to the small- and intermediate-conductance calcium-activated potassium (SK/IK) channel agonist NS309, and in response to increasing K+ concentration from 3–15 mM to activate inward rectifier potassium (KIR) channels. Basal production of NO and the sensitivity of vascular smooth muscle to NO were investigated using the NO synthase (NOS) inhibitor NG-nitro-L-arginine methyl ester (L-NAME, 10-3M) and the NO donor sodium nitroprusside (SNP; 10-5M), respectively. HpA structure and distensibility were determined by measuring lumen diameter and wall thickness of fully relaxed arterioles. Data are mean ± SEM and comparisons made using a one-way ANOVA with a post-hoc Bonferroni test. Results HpAs from PE rats dilated less when SK/IK channels were activated with NS309 compared to P and NP rats (55 ± 18% vs. 88 ± 2% and 90 ± 4%; p = 0.053). Activation of KIR with 15 mM K+ caused less dilation in HpAs from PE rats compared to P and NP rats, although this did not reach statistical significance (9 ± 8% vs. 61 ± 27% and 20 ± 11%; p = 0.13). NOS inhibition with L-NAME did not constrict any HpAs, suggesting there was no basal NO production. HpAs from PE rats were less sensitive to NO, with less reactivity to SNP compared to P and NP rats (22 ± 10% vs. 30 ± 10% and 38 ± 8%; p > 0.05). Structurally, lumen diameters were smaller in fully relaxed HpAs from PE rats than NP rats (Fig. 1), and vessel walls were thinner in PE and P rats compared to NP rats (7.7 ± 0.6 μm and 8.3 ± 0.7 μm vs. 11.5 ± 0.7 μm at 60 mmHg; p p Conclusion HpAs from PE rats had impaired dilatory responses, were less distensible, and underwent inward, hypotrophic remodeling making them structurally smaller than the NP and P states. This combination of impaired vasodilation and structural remodeling of HAs in PE could limit blood flow to the hippocampus during seizure, resulting in ischemic neuronal injury.

Inverse Relationship between Coffee Consumption and Cerebral Microbleeds in Men, but Not Women

Studies evaluating the association between coffee consumption and neurovascular diseases have frequently yielded contradictory results. The aim of this study was to investigate the association of coffee consumption with small-vessel disease (SVD) incidence in a healthy urban population while accounting for multiple demographic and lifestyle risk factors. This prospective study conducted from May 2013 through March 2014 included 455 participants (314 men and 141 women) aged 25 to 92 years. All subjects completed a questionnaire on coffee consumption and received a comprehensive neurologic examination, including magnetic resonance imaging, at St. Luke's International Hospital (Tokyo, Japan). Incidence of SVD was lower in male daily coffee drinkers than male nondrinkers and occasional drinkers, whereas incidence of white matter lesions was lower in female daily coffee drinkers than female nondrinkers or occasional drinkers. In multivariate analyses including age, sex, smoking status, and BMI, as well as coffee consumption, incidence of microbleeds was significantly lower in male daily coffee drinkers compared to nondrinkers. Daily coffee consumption is associated with reduced risk of cerebral microbleeds in men.

Patent foramen ovale and asymptomatic brain lesions in military fighter pilots

Background and purposePrevious studies have reported higher incidence of white matter lesions (WMLs) in military pilots. The anti-gravity straining maneuver, which fighter military pilots perform numerously during a flight is identical to the valsalva maneuver. We sought to investigate the prevalence of right-to-left shunt (RLS) associated with WMLs in military pilots. MethodsA prospective study was performed involving military pilots who visited the Airomedical Center. The pilots underwent brain magnetic resonance imaging (MRI) scan and transcranial Doppler (TCD) with intravenous injection of agitated saline solution for the detection of RLS. Periventricular WMLs (PVWMLs) on MRI were graded using Fazeka's scale, and deep WMLs (DWMLs) were graded using Scheltens's scale. ResultsThis study included 81 military pilots. RLS on TCD was observed less frequently in non-fighter pilots than in fighter pilots (35.5% vs. 64.5%, p=0.011). Fighter pilot was an independently associated factor with RLS on the TCD. DWMLs were independently associated with RLSs through a patent foramen ovale (PFO) (OR 3.507, 95% CI 1.223–10.055, p=0.02). ConclusionThe results suggest that DWMLs in military pilots may significantly be associated with RLS via PFO. Additional investigations are warranted.

A correlative study between white matter lesions of migraine and patent foramen ovale

Migraine is a kind of common primary headache, which seriously damages human healthand quality of life. Recent studies show there is a high incidence of white matter lesions(WML) inmigraineurs, which is independent of other risk factors for cerebrovascular diseases. The patent foramenovale(PFO) in migraineurs, especially in migraineurs with aura, is more common than in generalpopulation. There is a close relationship between them, but it is controversial whether it is a causal link.Patent foramen ovale can cause paradoxical embolism, but its role in the pathogenesis of migraine is stillunknown. It is worth exploring whether there is difference in white matter lesions between the migraineurswith and without patent foramen ovale.

Asymptomatic Brain Lesions on Cranial Magnetic Resonance Imaging in Inflammatory Bowel Disease

Background/AimsThis study aimed to examine the frequency and type of asymptomatic neurological involvement in inflammatory bowel disease (IBD) using cranial magnetic resonance imaging (MRI).MethodsFifty-one IBD patients with no known neurological diseases or symptoms and 30 controls with unspecified headaches without neurological origins were included. Patients and controls underwent cranial MRI assessments for white matter lesions, sinusitis, otitis-mastoiditis, and other brain parenchymal findings.ResultsThe frequencies of white matter lesions, other brainstem parenchymal lesions, and otitis-mastoiditis were similar in IBD patients and controls (p>0.05), whereas sinusitis was significantly more frequent in IBD patients (56.9% vs 33.3%, p=0.041). However, among those subjects with white matter lesions, the number of such lesions was significantly higher in IBD patients compared to controls (12.75±9.78 vs 3.20±2.90, p<0.05). The incidence of examined pathologies did not differ significantly with disease activity (p>0.05 for all).ConclusionsThe incidence of white matter lesions seemed to be similar in IBD patients and normal healthy individuals, and the lesions detected did not pose any clinical significance. However, long-term clinical follow-up of the lesions is warranted.

P139 Asymptomatic brain lesions on cranial magnetic resonance imaging in inflammatory bowel disease

Background/Aims: This study aimed to examine the fre-quency and type of asymptomatic neurological involvement in inflammatory bowel disease (IBD) using cranial magnetic resonance imaging (MRI). Methods: Fifty-one IBD patients with no known neurological diseases or symptoms and 30 controls with unspecified headaches without neurological ori-gins were included. Patients and controls underwent cranial MRI assessments for white matter lesions, sinusitis, otitis-mastoiditis, and other brain parenchymal findings. Results: The frequencies of white matter lesions, other brainstem parenchymal lesions, and otitis-mastoiditis were similar in IBD patients and controls (p>0.05), whereas sinusitis was significantly more frequent in IBD patients (56.9% vs 33.3%, p=0.041). However, among those subjects with white mat-ter lesions, the number of such lesions was significantly higher in IBD patients compared to controls (12.75±9.78 vs 3.20±2.90, p 0.05 for all). Conclusions: The incidence of white matter lesions seemed to be similar in IBD patients and normal healthy individuals, and the lesions detected did not pose any clini-cal significance. However, long-term clinical follow-up of the lesions is warranted. (Gut Liver 2013;7:169-174)Key Words: Inflammatory bowel disease; Asymptomatic brain lesion; Magnetic resonance imaging; White matter le-sionsINTRODUCTION

Cerebrovascular risk factors and MRI abnormalities in migraine

Case series have demonstrated an increased incidence of white matter lesions (WMLs) in patients with migraine. It is controversial whether the evidence of subclinical brain lesions relates to a higher risk of cerebrovascular disease. The objective of this study was to evaluate the association between magnetic resonance imaging (MRI) subclinical brain lesions and cerebrovascular risk factors (hyperhomocysteinaemia, MTHFR genotype, patent foramen ovale, hypertension, smoking and hypercholesterolaemia). From our database of 1201 patients followed at our Headache Clinic since September 2003 we analysed the MRI findings of 253 individuals. All MRI were blindly analysed by a second neuroradiologist (C.A.) and patients with WMLs (study group) were evaluated. In order to assess the association of WMLs with specific vascular risk factors, patients with WMLs were matched, according to age, sex and ICHD II diagnosis, with an equal number of individuals with normal MRI (control group). Headache was classified by the International Classification of Headache Disorders (ICHD 2004) criteria. We did not find any statistically significant difference between the two groups with regard to the presence of the cerebrovascular disease risk factors considered. Our results confirm that the WMLs are not related to the cerebrovascular disease risk factors.

Leucomalacia y ecogenicidad periventricular en prematuros de muy bajo peso al nacer

Cystic periventricular leukomalacia (c-PVL) and persistent periventricular echogenicity (PPVE) are white matter injuries of multifactorial etiology, high incidence in premature infants and with harmful effect in neurodevelopment.To determine PPVE and c-PVL incidence, and to assess potential predictors.Cohort of 164 very low birth weight premature infants (< 1,500 g and with gestational age equal or below 32 weeks), admitted to the Neonatal Care Unit of Hospital Clinico Regional de Valdivia, Chile. Cerebral ultrasound within the first week, at day 15 and day 30 of life was performed, and diagnosis of the lesions was made according Volpe's classification. The association of PPVE and c-PVL with several perinatal factors was evaluated by univariate risk estimation -relative risk (RR), and 95% confidence interval (95% CI)-, and then, multivariate analysis through multiple logistic regression -adjusted odds ratio (OR)--was carried out.The incidence of PPVE and c-PVL was 13.4 and 23.8%, respectively. 66.7% of c-PVL cases were observed in infants lower than 28 weeks (RR = 4.83; 95% CI = 2.72-8.58). The risk of c-PVL was lower with gestational age for each additional week (OR = 0.5; 95% CI = 0.38-0.65) and maternal hypertension (OR = 0.27; 95% CI = 0.08-0.87). A significant decrease of PPVE risk was found with better Apgar score after 1 minute and male sex. No association was found with either chorioamnionitis, antenatal corticosteroids nor other perinatal factors.This study confirms high incidence of white matter lesions, being gestational age a strong predictor of c-PVL. Studies are needed to clarify maternal hypertension effect on c-PVL development.

Prevalence of cranial scan abnormalities in preterm twins in relation to chorionicity and discordant birth weight

Objective: The purpose of this study was to determine the incidence of ultrasonographically detected cerebral white matter lesions (WMLs) in preterm twins at birth in relation to chorionicity, discordant weight and twin–twin transfusion syndrome (TTTS). Methods: In this retrospective study, perinatal, neonatal, and cranial scan data of 85 monochorionic (MC) and 94 dichorionic (DC) twin pregnancies (341 infants) delivered between 24 and 34 weeks of gestation were collected. Data were analysed according to chorionicity, discordant birth weight (>20%), single intrauterine death and TTTS. Results: The cerebral WML was seen in 14% of preterm twins. Monochorionic infants had higher risks of WML than DC twin (odds ratio 7.1; 95% CI 3.28–15.8). In MC group, discordant weight (37%), TTTS (38%), single intrauterine death (67%) had higher incidence of cerebral WML than concordant weight infants (7%). Similarly, incidence of WML was higher in DC discordant compared with concordant weight infants (13% versus 2%; P < 0.05). Conclusion: Monochorionic infants had a seven-fold higher incidence of cerebral WML than DC infants. Discordant birth weight, TTTS and survivor of co-twin demise are an independent risk of cerebral white matter lesion.

Antenatal steroids are associated with a reduction in the incidence of cerebral white matter lesions in very low birthweight infants

Aims: To investigate whether antenatal steroids reduce the incidence of cerebral white matter lesions in very low birthweight infants. Methods: A total of 224 newborn infants of < 31 weeks...

Leukoencephalopathy in HTLV-I-associated myelopathy/tropical spastic paraparesis: MRI analysis and a two year follow-up study after corticosteroid therapy

Magnetic resonance imaging (MRI) of the brain was studied in 35 patients with HTLV-I-associated myelopathy (HAM)/tropical spastic paraparesis (TSP), 19 HTLV-I seropositive carriers without HAM/TSP (non-HAM/TSP carriers), 18 patients with HTLV-I seronegative spastic spinal paraparesis (SSP), and 82 HTLV-I seronegative controls with other neurological disorders. The incidence of white matter lesions was significantly higher in HAM/TSP (66%) than in the controls (23%) and SSP (11%). HAM/TSP exceeded non-HAM/TSP carriers significantly in the incidence of multiple white matter lesions (37% vs 10%). HAM/TSP affected the deep and subcortical cerebral white matter multifocally, sparing the periventricular regions. None of the lesions were enhanced by gadolinium-DTPA. HAM/TSP patients with the white matter lesions had both a longer duration of disease and a greater disability than did those without lesions. The white matter lesions gradually increased in number, as the disability status became worse, in spite of the high dose corticosteroid treatment. All these observations suggest that the MRI abnormalities of the HAM/TSP brain may reflect the chronic perivascular inflammation with progressive gliosis (chronic disseminated encephalomyelitis). We propose that brain MRI can be successfully utilized as a reliable and non-invasive measure for following the disease progression in HAM/TSP.