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Wang C, Long Z, Wang XD, Kong YQ, Zhou LC, Jia WH, Li P, Wang J, Wang XJ, Tian T. Quantitative evaluation method of stroke association based on multidimensional gait parameters by using machine learning. Front Neuroinform 2025; 19:1544372. [PMID: 40012766 PMCID: PMC11861528 DOI: 10.3389/fninf.2025.1544372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Accepted: 01/28/2025] [Indexed: 02/28/2025] Open
Abstract
Objective NIHSS for stroke is widely used in clinical, but it is complex and subjective. The purpose of the study is to present a quantitative evaluation method of stroke association based on multi-dimensional gait parameters by using machine learning. Methods 39 ischemic stroke patients with hemiplegia were selected as the stroke group and 187 healthy adults from the community as the control group. Gaitboter system was used for gait analysis. Through the labeling of stroke patients by clinicians with NIHSS score, all gait parameters obtained were used to select appropriate gait parameters. By using machine learning algorithm, a discriminant model and a hierarchical model were trained. Results The discriminant model was used to distinguish between healthy people and stroke patients. The overall detection accuracy of the model based on KNN, SVM and Randomforest algorithms is 92.86, 92.86 and 90.00%, respectively. The hierarchical model was used to judge the severity of stroke in stroke patients. The model based on Randomforest, SVM and AdaBoost algorithm had an overall detection accuracy of 71.43, 85.71 and 85.71%, respectively. Conclusion The proposed stroke association quantitative evaluation method based on multi-dimensional gait parameters has the characteristics of high accuracy, objectivity, and quantification.
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Affiliation(s)
- Cheng Wang
- Jinan Zhougke Ubiquitous-Intelligent Institute of Computing Technology, Jinan, China
- Shandong Academy of Intelligent Computing Technology, Shandong Institutes of Industrial Technology (SDIIT), Jinan, China
- Ningbo Institute of Information Technology Application CAS, Ningbo, China
| | - Zhou Long
- Jinan Zhougke Ubiquitous-Intelligent Institute of Computing Technology, Jinan, China
- Shandong Academy of Intelligent Computing Technology, Shandong Institutes of Industrial Technology (SDIIT), Jinan, China
| | - Xiang-Dong Wang
- Bejing Key Laboratory of Mobile Computing and Pervasive Device, Beijing, China
- Institute of Computing Technology (ICT) Chinese Academy of Sciences (CAS), Beijing, China
| | - You-Qi Kong
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Li-Chun Zhou
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Wei-Hua Jia
- Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, Beijing, China
| | - Pei Li
- General Practice Department, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jing Wang
- General Practice Department, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiao-Juan Wang
- General Practice Department, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Tian Tian
- General Practice Department, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Li N, Li YL, Li LT. Development and validation of a nomogram predictive model for cerebral small vessel disease: a comprehensive retrospective analysis. Front Neurol 2024; 14:1340492. [PMID: 38259650 PMCID: PMC10801164 DOI: 10.3389/fneur.2023.1340492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
Background Cerebral small vessel disease (CSVD) is a significant contributor to stroke, intracerebral hemorrhages, and vascular dementia, particularly in the elderly. Early diagnosis remains challenging. This study aimed to develop and validate a novel nomogram for the early diagnosis of cerebral small vessel disease (CSVD). We focused on integrating cerebrovascular risk factors and blood biochemical markers to identify individuals at high risk of CSVD, thus enabling early intervention. Methods In a retrospective study conducted at the neurology department of the Affiliated Hospital of Hebei University from January 2020 to June 2022, 587 patients were enrolled. The patients were randomly divided into a training set (70%, n = 412) and a validation set (30%, n = 175). The nomogram was developed using multivariable logistic regression analysis, with variables selected through the Least Absolute Shrinkage and Selection Operator (LASSO) technique. The performance of the nomogram was evaluated based on the area under the receiver operating characteristic curve (AUC-ROC), calibration plots, and decision curve analysis (DCA). Results Out of 88 analyzed biomarkers, 32 showed significant differences between the CSVD and non-CSVD groups. The LASSO regression identified 12 significant indicators, with nine being independent clinical predictors of CSVD. The AUC-ROC values of the nomogram were 0.849 (95% CI: 0.821-0.894) in the training set and 0.863 (95% CI: 0.810-0.917) in the validation set, indicating excellent discriminative ability. Calibration plots demonstrated good agreement between predicted and observed probabilities in both sets. DCA showed that the nomogram had significant clinical utility. Conclusions The study successfully developed a nomogram predictive model for CSVD, incorporating nine clinical predictive factors. This model offers a valuable tool for early identification and risk assessment of CSVD, potentially enhancing clinical decision-making and patient outcomes.
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Affiliation(s)
- Ning Li
- Department of Neurology, Hebei Medical University, Shijiazhuang, China
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, China
| | - Ying-lei Li
- Department of Neurology, Hebei Medical University, Shijiazhuang, China
- Department of Emergency Medicine, Baoding First Central Hospital, Baoding, China
| | - Li-tao Li
- Department of Neurology, Hebei Medical University, Shijiazhuang, China
- Department of Neurology, Hebei General Hospital, Shijiazhuang, China
- Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Hebei General Hospital, Shijiazhuang, China
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Association between retinal vessel density and neuroimaging features and cognitive impairment in cerebral small vessel disease. Clin Neurol Neurosurg 2022; 221:107407. [PMID: 35933965 DOI: 10.1016/j.clineuro.2022.107407] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 11/20/2022]
Abstract
AIMS This study aimed to investigate the associations among retinal vessel density (RVD), neuroimaging features and cognitive impairment in patients with sporadic cerebral small vessel disease (CSVD). METHODS This was a prospective observational study. A total of forty-nine patients with CSVD were recruited. The CSVD imaging burden was calculated by using a scoring system with a total score of 4 that assigns one point each for severe white matter hyperintensities (WMH), lacune, microbleeds (MBs), and basal-ganglia perivascular space (BG-PVS). Patients with a burden score ≥ 2 were classified as having a moderate/severe burden, and those with a score ≤ 1 were classified as the having a none/mild burden. The RVD in the superficial retinal capillary plexus (SRCP) and deep retinal capillary plexus (DRCP) was evaluated by using optical coherence tomography angiography (OCTA). The associations among the RVD values, CSVD imaging features, and cognitive impairment were evaluated. RESULTS Patients with a moderate/severe CSVD burden showed lower RVD values in the para-fovea and peri-fovea areas of the left DRCP than patients with none/mild burden (para-fovea, β coefficient= -0.185 [-0.351~-0.015], P = 0.003; peri-fovea, β coefficient= -0.113 [-0.208~-0.018], P = 0.021). The RVD values in the para-fovea and peri-fovea areas of the left DRCP were significantly associated with the CSVD burden score after adjusting for age and vascular risk factors (P = 0.030 and P = 0.021, respectively) and with severe WMH (para-fovea, R = -0.398, P = 0.005; peri-fovea, R= -0.443, P = 0.001) and BG-PVS (para-fovea, R = -0.445, P = 0.001; peri-fovea, R= -0.396, P = 0.005). Neither para-fovea nor peri-fovea RVD values had a marked association with cognition. CONCLUSION The RVD in the left DRCP may reflect the presence of cerebral small vessel lesions and might be a useful tool for predicting the neuroimaging-based burden of CSVD.
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Yang S, Li X, Qin W, Yang L, Hu W. Association Between Large Numbers of Enlarged Perivascular Spaces in Basal Ganglia and Motor Performance in Elderly Individuals: A Cross-Sectional Study. Clin Interv Aging 2022; 17:903-913. [PMID: 35677185 PMCID: PMC9169974 DOI: 10.2147/cia.s364794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/16/2022] [Indexed: 12/20/2022] Open
Abstract
Background and Objective Motor dysfunction is common in the elderly, and is associated with adverse consequences. Enlarged perivascular spaces in basal ganglia (BG-EPVSs) are considered an MRI marker of cerebral small-vessel diseases. However, the consequences of BG-EPVSs are largely unknown. In the present study, we aimed to explore the association between large numbers of BG-EPVSs and motor performance. Methods We prospectively recruited elderly individuals in the Neurology Department of our hospital from December 1, 2020 to January 31, 2022. Participants with >20 BG-EPVSs on the unilateral side of the slice containing the most EPVSs were classified as the BG-EPVS group (n=99) and the rest as controls (n=193). Motor performance was assessed by quantitative gait analysis, Tinetti test, timed up-and-go (TUG) test, and the Short Physical Performance Battery (SPPB). Spearman correlation analysis and multivariate linear regression analysis were performed to investigate the association between BG-EPVSs and motor performance. Results Compared with the control group, the BG-EPVS group had lower gait speed and cadence, shorter stride length, longer TUG duration, and lower Tinetti gait test, Tinetti balance test, and SPPB scores (P<0.01). Spearman correlation analysis showed that BG-EPVSs were negatively related to gait speed, gait cadence, stride length, and Tinetti gait test, Tinetti balance test, and SPPB scores (ρ= –0.539 to –0.223, P<0.001) and positively related to TUG duration (ρ=0.397, P<0.001). Regression analysis indicated that BG-EPVSs were an independent risk factor of lower gait speed, shorter stride length, poor balance, and poor general physical performance after adjusting for confounders (β= –0.313 to –0.206, P<0.01). Conclusion Large numbers of BG-EPVSs were independently related to poor gait, balance, and general physical performance in elderly individuals, which provides information about the consequences of BG-EPVSs and risk factors for motor dysfunction.
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Affiliation(s)
- Shuna Yang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xuanting Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wei Qin
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Lei Yang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
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Yu X, Yu Y, Wei C, Wang L, Jiang J, Zhang R, Dai Q, Kang Y, Chen X. Association between small dense low-density lipoprotein cholesterol and neuroimaging markers of cerebral small vessel disease in middle-aged and elderly Chinese populations. BMC Neurol 2021; 21:436. [PMID: 34753453 PMCID: PMC8576978 DOI: 10.1186/s12883-021-02472-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebral small vascular disease (CSVD) is one of the leading causes of death in the aged population and is closely related to abnormalities in low-density lipoprotein cholesterol (LDL-C). Our study aims to clarify the relationship between small and dense low-density lipoprotein cholesterol (sdLDL-C) (a subcomponent of LDL-C) and neuroimaging markers of CSVD. METHODS In total, 1211 Chinese adults aged ≥45 years with cranial magnetic resonance imaging (MRI) were recruited in this retrospective study from January 2018 to May 2021. Serum lipids and other baseline characteristics were investigated in relation to the occurrence of CSVD. A logistic regression model was performed to analyze the relationships between LDL subtypes and CSVD risk, and the Pearson correlation coefficient was used to analyze the correlation between clinical characteristics and CSVD risk. ROC curves and AUCs were created and depicted to predict the best cutoff value of LDL-C subtypes for CSVD risk. Based on these data, we performed comprehensive analyses to investigate the risk factors for CSVD. RESULTS Ultimately, 623 eligible patients were included in the present study. Of the 623 eligible patients, 487 were included in the CSVD group, and 136 were included in the group without CSVD (control group). We adjusted for confounders in the multivariate logistic regression model, and LDL-C3 was still higher in the CSVD patients than in the group of those without CSVD (OR (95% CI), 1.22(1.08-1.38), P < 0.05). Pearson correlation showed that there was a positive correlation between the levels of LDL-C3, LDL-C4, LDL-C5, glucose, age, hypertension, previous ischemic stroke and CSVD risk (r > 0.15, P < 0.01). Moreover, the best cutoff value of LDL-C3 to predict CSVD was 9.5 mg/dL with 68.4% sensitivity and 72.8% specificity, and the best cutoff value of LDL-C4 to predict CSVD was 5.5 mg/dL with 50.5% sensitivity and 90.4% specificity. CONCLUSION The results indicate that LDL-C3 is an independent risk factor for CSVD. A new prediction model based on LDL-C3 and LDL-C4 can help clinicians identify high-risk CSVD, even in people with normal LDL-C levels. The levels of sdLDL-C should be considered in the assessment and management of CSVD.
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Affiliation(s)
- Xiaorong Yu
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Yanhua Yu
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Cunsheng Wei
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Lin Wang
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Junying Jiang
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Rui Zhang
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Qi Dai
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Yue Kang
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Xuemei Chen
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China.
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Jiménez-Balado J, Riba-Llena I, Maisterra O, Pizarro J, Palasí A, Pujadas F, Mundet X, Vinyoles E, Delgado P. Ambulatory Blood Pressure Levels in the Prediction of Progression of Cerebral Small Vessel Disease. J Am Geriatr Soc 2020; 68:2232-2239. [PMID: 32511756 DOI: 10.1111/jgs.16568] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/30/2020] [Accepted: 05/03/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES We aimed to study the value of ambulatory blood pressure monitoring (ABPM) in predicting the global progression of cerebral small vessel disease (cSVD). DESIGN Longitudinal cohort study. SETTING Data from the population-based Investigating Silent Strokes in Hypertensives study. PARTICIPANTS Individuals with hypertension who were 50 to 70 years of age and stroke free at baseline. In baseline and follow-up visits, patients underwent magnetic resonance imaging and ABPM. MEASUREMENTS Ambulatory systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels were studied as continuous variables and dichotomized according to good or poor control on the basis of 125/75 (24 hours), 130/80 (day), and 110/65 (night) mm Hg cutoff values. Whole cSVD progression was qualitatively scored with 1 point when an incident lesion (incident lacunar infarcts, deep cerebral microbleeds, white matter hyperintensities, and basal ganglia enlarged perivascular spaces) was detected. The score ranged from 0 to 4. RESULTS We followed up 233 participants with a median age of 65 years within 4 years. A total of 61 (26.2%) and 23 (9.9%) subjects showed cSVD progression in one and two or more markers, respectively. Baseline ambulatory SBP and DBP and nighttime pulse pressure (PP) values were positively correlated with the number of incident cSVD lesions. Interestingly, patients without incident lesions showed greater differences between office and ambulatory BP, thus suggesting an increased white coat effect. Poor DBP control, nighttime PP, and DBP white coat effect were independently associated with cSVD progression. The inclusion of these metrics in a clinical model resulted in a significant increase in the prediction of incident lesions (integrated discrimination improvement = 9.09%; P value <.001). CONCLUSION ABPM may help assess cSVD risk of progression, especially by the identification of poor BP control, masked hypertension, and increased nighttime PP. J Am Geriatr Soc 68:2232-2239, 2020.
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Affiliation(s)
- Joan Jiménez-Balado
- Neurovascular Research Lab, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Iolanda Riba-Llena
- Neurovascular Research Lab, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Olga Maisterra
- Neurovascular Research Lab, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.,Dementia Unit, Neurology Service, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jesús Pizarro
- Neurovascular Research Lab, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antoni Palasí
- Dementia Unit, Neurology Service, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesc Pujadas
- Dementia Unit, Neurology Service, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Mundet
- Primary Healthcare University Research Institute IDIAP Jordi Gol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ernest Vinyoles
- Primary Healthcare University Research Institute IDIAP Jordi Gol, CAP La Mina, Universitat de Barcelona, Barcelona, Spain
| | - Pilar Delgado
- Neurovascular Research Lab, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.,Dementia Unit, Neurology Service, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
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7
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Distinct profiles of cognitive impairment associated with different silent cerebrovascular lesions in hypertensive elderly Chinese. J Neurol Sci 2019; 403:139-145. [DOI: 10.1016/j.jns.2019.06.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 06/18/2019] [Accepted: 06/26/2019] [Indexed: 12/17/2022]
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8
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Minnerup J, Strecker JK, Wachsmuth L, Hoppen M, Schmidt A, Hermann DM, Wiendl H, Meuth S, Faber C, Diederich K, Schäbitz WR. Defining mechanisms of neural plasticity after brainstem ischemia in rats. Ann Neurol 2018; 83:1003-1015. [PMID: 29665155 DOI: 10.1002/ana.25238] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 04/13/2018] [Accepted: 04/13/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Neurological recovery after stroke mainly depends on the location of the lesion. A substantial portion of strokes affects the brainstem. However, patterns of neural plasticity following brainstem ischemia are almost unknown. METHODS Here, we established a rat brainstem ischemia model that resembles key features of the human disease and investigated mechanisms of neural plasticity, including neurogenesis and axonal sprouting as well as secondary neurodegeneration. RESULTS Spontaneous functional recovery was accompanied by a distinct pattern of axonal sprouting, for example, an increased bilateral fiber outgrowth from the corticorubral tract to the respective contralesional red nucleus suggesting a compensatory role of extrapyramidal pathways after damage to pyramid tracts within the brainstem. Using different markers for DNA replication, we showed that the brainstem displays a remarkable ability to undergo specific plastic cellular changes after injury, highlighting a yet unknown pattern of neurogenesis. Neural progenitor cells proliferated within the dorsal brainstem and migrated toward the lesion, whereas neurogenesis in classic neurogenic niches, the subventricular zone of the lateral ventricle and the hippocampus, remained, in contrast to what is known from hemispheric stroke, unaffected. These beneficial changes were paralleled by long-term degenerative processes, that is, corticospinal fiber loss superior to the lesion, degeneration of spinal tracts, and a decreased neuron density within the ipsilesional substantia nigra and the contralesional red nucleus that might have limited further functional recovery. INTERPRETATION Our findings provide knowledge of elementary plastic adaptions after brainstem stroke, which is fundamental for understanding the human disease and for the development of new treatments. Ann Neurol 2018;83:1003-1015.
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Affiliation(s)
- Jens Minnerup
- Department of Neurology, University of Münster, Münster, Germany
| | | | - Lydia Wachsmuth
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | - Maike Hoppen
- Department of Neurology, University of Münster, Münster, Germany
| | - Antje Schmidt
- Department of Neurology, University of Münster, Münster, Germany
| | - Dirk M Hermann
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
| | - Heinz Wiendl
- Department of Neurology, University of Münster, Münster, Germany
| | - Sven Meuth
- Department of Neurology, University of Münster, Münster, Germany
| | - Cornelius Faber
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | - Kai Diederich
- Department of Neurology, University of Münster, Münster, Germany
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van Leijsen EMC, Bergkamp MI, van Uden IWM, Ghafoorian M, van der Holst HM, Norris DG, Platel B, Tuladhar AM, de Leeuw FE. Progression of White Matter Hyperintensities Preceded by Heterogeneous Decline of Microstructural Integrity. Stroke 2018; 49:1386-1393. [PMID: 29724890 DOI: 10.1161/strokeaha.118.020980] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/27/2018] [Accepted: 04/05/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE White matter hyperintensities (WMH) are frequently seen on neuroimaging of elderly and are associated with cognitive decline and the development of dementia. Yet, the temporal dynamics of conversion of normal-appearing white matter (NAWM) into WMH remains unknown. We examined whether and when progression of WMH was preceded by changes in fluid-attenuated inversion recovery and diffusion tensor imaging values, thereby taking into account differences between participants with mild versus severe baseline WMH. METHODS From 266 participants of the RUN DMC study (Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Imaging Cohort), we semiautomatically segmented WMH at 3 time points for 9 years. Images were registered to standard space through a subject template. We analyzed differences in baseline fluid-attenuated inversion recovery, fractional anisotropy, and mean diffusivity (MD) values and changes in MD values over time between 4 regions: (1) remaining NAWM, (2) NAWM converting into WMH in the second follow-up period, (3) NAWM converting into WMH in the first follow-up period, and (4) WMH. RESULTS NAWM converting into WMH in the first or second time interval showed higher fluid-attenuated inversion recovery and MD values than remaining NAWM. MD values in NAWM converting into WMH in the first time interval were similar to MD values in WMH. When stratified by baseline WMH severity, participants with severe WMH had higher fluid-attenuated inversion recovery and MD and lower fractional anisotropy values than participants with mild WMH, in all areas including the NAWM. MD values in WMH and in NAWM that converted into WMH continuously increased over time. CONCLUSIONS Impaired microstructural integrity preceded conversion into WMH and continuously declined over time, suggesting a continuous disease process of white matter integrity loss that can be detected using diffusion tensor imaging even years before WMH become visible on conventional neuroimaging. Differences in microstructural integrity between participants with mild versus severe WMH suggest heterogeneity of both NAWM and WMH, which might explain the clinical variability observed in patients with similar small vessel disease severity.
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Affiliation(s)
- Esther M C van Leijsen
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Donders Center for Medical Neuroscience (E.M.C.v.L., M.I.B., I.W.M.v.U., A.M.T., F.-E.d.L.)
| | - Mayra I Bergkamp
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Donders Center for Medical Neuroscience (E.M.C.v.L., M.I.B., I.W.M.v.U., A.M.T., F.-E.d.L.)
| | - Ingeborg W M van Uden
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Donders Center for Medical Neuroscience (E.M.C.v.L., M.I.B., I.W.M.v.U., A.M.T., F.-E.d.L.)
| | - Mohsen Ghafoorian
- Department of Radiology and Nuclear Medicine, Diagnostic Image Analysis Group (M.G., B.P.), Radboud University Medical Center, Nijmegen, the Netherlands.,Institute for Computing and Information Sciences (M.G.)
| | - Helena M van der Holst
- Department of Neurology, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands (H.M.v.d.H.)
| | - David G Norris
- Donders Institute for Brain, Cognition, and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands.,Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Germany (D.G.N.)
| | - Bram Platel
- Department of Radiology and Nuclear Medicine, Diagnostic Image Analysis Group (M.G., B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anil M Tuladhar
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Donders Center for Medical Neuroscience (E.M.C.v.L., M.I.B., I.W.M.v.U., A.M.T., F.-E.d.L.)
| | - Frank-Erik de Leeuw
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Donders Center for Medical Neuroscience (E.M.C.v.L., M.I.B., I.W.M.v.U., A.M.T., F.-E.d.L.)
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10
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Schaapsmeerders P, Tuladhar AM, Maaijwee NAM, Rutten-Jacobs LCA, Arntz RM, Schoonderwaldt HC, Dorresteijn LDA, van Dijk EJ, Kessels RPC, de Leeuw FE. Lower Ipsilateral Hippocampal Integrity after Ischemic Stroke in Young Adults: A Long-Term Follow-Up Study. PLoS One 2015; 10:e0139772. [PMID: 26462115 PMCID: PMC4603678 DOI: 10.1371/journal.pone.0139772] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 09/17/2015] [Indexed: 11/18/2022] Open
Abstract
Background and purpose Memory impairment after stroke is poorly understood as stroke rarely occurs in the hippocampus. Previous studies have observed smaller ipsilateral hippocampal volumes after stroke compared with controls. Possibly, these findings on macroscopic level are not the first occurrence of structural damage and are preceded by microscopic changes that may already be associated with a worse memory function. We therefore examined the relationship between hippocampal integrity, volume, and memory performance long after first-ever ischemic stroke in young adults. Methods We included all consecutive first-ever ischemic stroke patients, without hippocampal strokes or recurrent stroke/TIA, aged 18–50 years, admitted to our academic hospital between 1980 and 2010. One hundred and forty-six patients underwent T1 MPRAGE, DTI scanning and completed the Rey Auditory Verbal Learning Test and were compared with 84 stroke-free controls. After manual correction of hippocampal automatic segmentation, we calculated mean hippocampal fractional anisotropy (FA) and diffusivity (MD). Results On average 10 years after ischemic stroke, lesion volume was associated with lower ipsilateral hippocampal integrity (p<0.05), independent of hippocampal volume. In patients with a normal ipsilateral hippocampal volume (volume is less than or equal to 1.5 SD below the mean volume of controls) significant differences in ipsilateral hippocampal MD were observed (p<0.0001). However, patients with a normal hippocampal volume and high hippocampal MD did not show a worse memory performance compared with patients with a normal volume and low hippocampal MD (p>0.05). Conclusions Patients with average ipsilateral hippocampal volume could already have lower ipsilateral hippocampal integrity, although at present with no attendant worse memory performance compared with patients with high hippocampal integrity. Longitudinal studies are needed to investigate whether a low hippocampal integrity after stroke might lead to exacerbated memory decline with increasing age.
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Affiliation(s)
- Pauline Schaapsmeerders
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - Anil M. Tuladhar
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - Noortje A. M. Maaijwee
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | | | - Renate M. Arntz
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - Hennie C. Schoonderwaldt
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | | | - Ewoud J. van Dijk
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - Roy P. C. Kessels
- Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience and Centre for Cognition, Radboud University Nijmegen, Nijmegen, the Netherlands
- Department of Medical Psychology, Radboud university medical centre, Nijmegen, the Netherlands
| | - Frank-Erik de Leeuw
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
- * E-mail:
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Quantitative T2, T2*, and T2' MR imaging in patients with ischemic leukoaraiosis might detect microstructural changes and cortical hypoxia. Neuroradiology 2015; 57:1023-30. [PMID: 26227168 DOI: 10.1007/s00234-015-1565-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 07/13/2015] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Quantitative MRI with T2, T2*, and T2' mapping has been shown to non-invasively depict microstructural changes (T2) and oxygenation status (T2* and T2') that are invisible on conventional MRI. Therefore, we aimed to assess whether T2 and T2' quantification detects cerebral (micro-)structural damage and chronic hypoxia in lesions and in normal appearing white matter (WM) and gray matter (GM) of patients with ischemic leukoaraiosis (IL). Measurements were complemented by the assessment of the cerebral blood flow (CBF) and the degree of GM and WM atrophy. METHODS Eighteen patients with IL and 18 age-matched healthy controls were included. High-resolution, motion-corrected T2, T2*, and T2' mapping, CBF mapping (pulsed arterial spin labeling, PASL), and segmentation of GM and WM were used to depict specific changes in both groups. All parameters were compared between patients and healthy controls, using t testing. Values of p < 0.05 were accepted as statistically significant. RESULTS Patients showed significantly increased T2 in lesions (p < 0.01) and in unaffected WM (p = 0.045) as well as significantly increased T2* in lesions (p = 0.003). A significant decrease of T2' was detected in patients in unaffected WM (p = 0.027), while no T2' changes were observed in GM (p = 0.13). Both unaffected WM and GM were significantly decreased in volume in the patient-group (p < 0.01). No differences of PASL-based CBF could be shown. CONCLUSION Non-invasive quantitative MRI with T2, T2*, and T2' mapping might be used to detect subtle structural and metabolic changes in IL. Assessing the grade of microstructural damage and hypoxia might be helpful to monitor disease progression and to perform risk assessment.
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Arboix A. Cardiovascular risk factors for acute stroke: Risk profiles in the different subtypes of ischemic stroke. World J Clin Cases 2015; 3:418-429. [PMID: 25984516 PMCID: PMC4419105 DOI: 10.12998/wjcc.v3.i5.418] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 01/14/2015] [Accepted: 02/12/2015] [Indexed: 02/05/2023] Open
Abstract
Timely diagnosis and control of cardiovascular risk factors is a priority objective for adequate primary and secondary prevention of acute stroke. Hypertension, atrial fibrillation and diabetes mellitus are the most common risk factors for acute cerebrovascular events, although novel risk factors, such as sleep-disordered breathing, inflammatory markers or carotid intima-media thickness have been identified. However, the cardiovascular risk factors profile differs according to the different subtypes of ischemic stroke. Atrial fibrillation and ischemic heart disease are more frequent in patients with cardioembolic infarction, hypertension and diabetes in patients with lacunar stroke, and vascular peripheral disease, hypertension, diabetes, previous transient ischemic attack and chronic obstructive pulmonary disease in patients with atherothrombotic infarction. This review aims to present updated data on risk factors for acute ischemic stroke as well as to describe the usefulness of new and emerging vascular risk factors in stroke patients.
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Duering M, Righart R, Wollenweber FA, Zietemann V, Gesierich B, Dichgans M. Acute infarcts cause focal thinning in remote cortex via degeneration of connecting fiber tracts. Neurology 2015; 84:1685-92. [PMID: 25809303 DOI: 10.1212/wnl.0000000000001502] [Citation(s) in RCA: 143] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 01/14/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To study remote effects distant from acute ischemic infarcts by measuring longitudinal changes of cortical thickness in connected brain regions as well as changes in microstructural integrity in connecting fiber tracts. METHODS Thirty-two patients (mean age 71 years) underwent a standardized protocol including multimodal MRI and clinical assessment both at stroke onset and 6 months after the event. Cortex connected to acute infarcts was identified by probabilistic diffusion tensor tractography starting from the acute lesion. Changes of cortical thickness were measured using the longitudinal stream of FreeSurfer. Microstructural damage in white matter tracts was assessed by changes of mean diffusivity. RESULTS We found focal cortical thinning specifically in areas connected to acute infarcts (p < 0.001). Thinning was more pronounced in regions showing a high probability of connectivity to infarcts. Microstructural damage in white matter tracts connecting acute infarcts with distant cortex significantly correlated with thickness changes in that region (ρ = -0.39, p = 0.028). There was no indication of an influence of cavitation status or infarct etiology on the observed changes in cortex and white matter. CONCLUSIONS These findings identify secondary degeneration of connected white matter tracts and remote cortex as key features of acute ischemic infarcts. Our observations may have implications for the understanding of structural and functional reorganization after stroke.
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Affiliation(s)
- Marco Duering
- From the Institute for Stroke and Dementia Research (M.D., R.R., F.A.W., V.Z., B.G., M.D.), Klinikum der Universität München, Ludwig-Maximilians University, Munich; German Center for Neurodegenerative Diseases (DZNE, Munich) (R.R., M.D.), Munich; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Munich, Germany. R.R. is currently with the Department of Neurology, Technische Universität München, Munich, Germany
| | - Ruthger Righart
- From the Institute for Stroke and Dementia Research (M.D., R.R., F.A.W., V.Z., B.G., M.D.), Klinikum der Universität München, Ludwig-Maximilians University, Munich; German Center for Neurodegenerative Diseases (DZNE, Munich) (R.R., M.D.), Munich; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Munich, Germany. R.R. is currently with the Department of Neurology, Technische Universität München, Munich, Germany
| | - Frank Arne Wollenweber
- From the Institute for Stroke and Dementia Research (M.D., R.R., F.A.W., V.Z., B.G., M.D.), Klinikum der Universität München, Ludwig-Maximilians University, Munich; German Center for Neurodegenerative Diseases (DZNE, Munich) (R.R., M.D.), Munich; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Munich, Germany. R.R. is currently with the Department of Neurology, Technische Universität München, Munich, Germany
| | - Vera Zietemann
- From the Institute for Stroke and Dementia Research (M.D., R.R., F.A.W., V.Z., B.G., M.D.), Klinikum der Universität München, Ludwig-Maximilians University, Munich; German Center for Neurodegenerative Diseases (DZNE, Munich) (R.R., M.D.), Munich; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Munich, Germany. R.R. is currently with the Department of Neurology, Technische Universität München, Munich, Germany
| | - Benno Gesierich
- From the Institute for Stroke and Dementia Research (M.D., R.R., F.A.W., V.Z., B.G., M.D.), Klinikum der Universität München, Ludwig-Maximilians University, Munich; German Center for Neurodegenerative Diseases (DZNE, Munich) (R.R., M.D.), Munich; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Munich, Germany. R.R. is currently with the Department of Neurology, Technische Universität München, Munich, Germany
| | - Martin Dichgans
- From the Institute for Stroke and Dementia Research (M.D., R.R., F.A.W., V.Z., B.G., M.D.), Klinikum der Universität München, Ludwig-Maximilians University, Munich; German Center for Neurodegenerative Diseases (DZNE, Munich) (R.R., M.D.), Munich; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Munich, Germany. R.R. is currently with the Department of Neurology, Technische Universität München, Munich, Germany.
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Kvistad CE, Oygarden H, Logallo N, Moen G, Thomassen L, Waje-Andreassen U, Naess H. A dark side of subcortical diffusion-weighted lesions? Characteristics, cause, and outcome in large subcortical infarction: the Bergen Norwegian stroke cooperation study. Stroke 2014; 45:2710-6. [PMID: 25013025 DOI: 10.1161/strokeaha.114.005781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Diffusion-weighted imaging (DWI) is highly accurate in identifying and locating ischemic stroke injury. Few studies using DWI have investigated large subcortical infarctions (LSIs). We aimed to study clinical characteristics, cause, and outcome in patients with ischemic stroke with LSI diagnosed on DWI and compare these with those who had lacunar DWI lesions or DWI lesions located elsewhere. METHODS Patients with stroke admitted between February 2006 and July 2013 were prospectively registered in a stroke database and examined with DWI. Patients with DWI lesions classified as LSI (subcortical, ≥15 mm) were compared with those with lacunar lesions (subcortical, <15 mm, lacunar infarction [LI]), cortical lesions (cortical infarction [CI]), or no LSI, which included LI, CI, mixed cortical-subcortical, cerebellar, brain stem, and combined lesion locations. RESULTS A total of 1886 patients with ischemic stroke were included, of which 128 patients (6.8%) had LSI, 317 (16.8%) LI, and 544 (28.8%) CI. The no LSI group included 1758 patients. Occlusive pathology in the proximal middle cerebral artery was more frequent in patients with acute stroke with LSI. Lacunar syndrome was associated with LSI when compared with CI and no LSI. Unknown cause was frequent in the LSI group (60.4%) and independently associated with LSI in the LSI versus LI (P<0.001), LSI versus CI (P=0.002), and LSI versus no LSI population (P<0.001). LSI was independently associated with unfavorable outcome, whether compared with LI (P=0.002), CI (P<0.001), or no LSI (P=0.002). CONCLUSIONS LSI is associated with distinct clinical characteristics, unknown cause, and unfavorable outcome, which separates this stroke entity from patients with lacunar subcortical DWI lesions or DWI lesions located elsewhere.
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Affiliation(s)
- Christopher Elnan Kvistad
- From the Departments of Neurology (C.E.K., H.O., N.L., L.T., U.W.-A., H.N.) and Radiology (G.M.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway (C.E.K., L.T.); and Centre of Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (H.N.).
| | - Halvor Oygarden
- From the Departments of Neurology (C.E.K., H.O., N.L., L.T., U.W.-A., H.N.) and Radiology (G.M.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway (C.E.K., L.T.); and Centre of Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (H.N.)
| | - Nicola Logallo
- From the Departments of Neurology (C.E.K., H.O., N.L., L.T., U.W.-A., H.N.) and Radiology (G.M.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway (C.E.K., L.T.); and Centre of Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (H.N.)
| | - Gunnar Moen
- From the Departments of Neurology (C.E.K., H.O., N.L., L.T., U.W.-A., H.N.) and Radiology (G.M.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway (C.E.K., L.T.); and Centre of Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (H.N.)
| | - Lars Thomassen
- From the Departments of Neurology (C.E.K., H.O., N.L., L.T., U.W.-A., H.N.) and Radiology (G.M.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway (C.E.K., L.T.); and Centre of Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (H.N.)
| | - Ulrike Waje-Andreassen
- From the Departments of Neurology (C.E.K., H.O., N.L., L.T., U.W.-A., H.N.) and Radiology (G.M.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway (C.E.K., L.T.); and Centre of Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (H.N.)
| | - Halvor Naess
- From the Departments of Neurology (C.E.K., H.O., N.L., L.T., U.W.-A., H.N.) and Radiology (G.M.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway (C.E.K., L.T.); and Centre of Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (H.N.)
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Arboix A, Blanco-Rojas L, Martí-Vilalta JL. Advancements in understanding the mechanisms of symptomatic lacunar ischemic stroke: translation of knowledge to prevention strategies. Expert Rev Neurother 2014; 14:261-76. [PMID: 24490992 DOI: 10.1586/14737175.2014.884926] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Symptomatic lacunar ischemic stroke (25% of all brain infarctions) results from occlusion of a single penetrating artery by microatheromas or lipohyalinosis and rarely from an intracranial atheromatous branch disease. Recurrent lacunar stroke may be associated with more severe clinical features and has been involved in producing lacunar state and vascular subcortical dementia. In the first multicenter randomized clinical trial (SPS3) focused on stroke prevention among patients with recent lacunar stroke, the addition of clopidogrel to aspirin not only did not reduced significantly the risk of recurrent stroke, but also increased significantly the likelihood of hemorrhage and fatal outcome. If lacunar stroke is primarily non-atherothromboembolic, secondary prevention aimed at preventing atheroma progression may not be very effective. The efficacy of drugs that improve endothelial function in lacunar stroke patients remains to be studied in the future.
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Affiliation(s)
- Adrià Arboix
- Department of Neurology, Cerebrovascular Division, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, C/Viladomat 288, E-08029 Barcelona, Catalonia, Spain
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Blanco-Rojas L, Arboix A, Canovas D, Grau-Olivares M, Oliva Morera JC, Parra O. Cognitive profile in patients with a first-ever lacunar infarct with and without silent lacunes: a comparative study. BMC Neurol 2013; 13:203. [PMID: 24341857 PMCID: PMC3866944 DOI: 10.1186/1471-2377-13-203] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 12/11/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The detection of early neuropsychological abnormalities as precursors of cognitive decline of vascular origin in patients with lacunar stroke is a subject of increasing interest. The objective of this study was to assess whether there were differences in the performance of a battery of neuropsychological tests in first-ever lacunar stroke patients with and without associated silent multiple lacunar infarctions found incidentally on the brain magnetic resonance imaging (MRI) scan. METHODS A total of 72 consecutive patients with first-ever lacunar infarction were studied 1 month after stroke. All patients underwent a comprehensive neuropsychological evaluation, which included the California Verbal Learning Test (CVLT), Phonetic Verbal Fluency Test (PMR), Semantic Verbal Fluency Test (category "animals"), Digit Span Forward and Backward from the Wechsler Adult Intelligence Scale (WAIS-III), and Mini-Mental State Examination (MMSE). RESULTS A total of 38 patients (52.7%) had silent multiple lacunar infarcts, with corona radiata as the most frequent topography (P < 0.023). White matter hyperintensities (leukoaraiosis) were observed in 81.1% of patients with silent multiple lacunar infarcts and in 50% with a single lacunar infarction (P < 0.007). Patients in both groups showed similar scores in the MMSE, but those with associated silent lacunar infarctions showed a poorer performance in the semantic fluency test (P < 0.008) and in short delayed verbal memory (P < 0.001). In both cases, however, leukoaraiosis was not statistically significant in multivariate linear regression models adjusted by confounding covariates. In these models, multiple silent lacunar infarctions and education were independent predictors of poor performance in the semantic fluency test and in short delayed verbal memory. CONCLUSIONS The presence of silent multiple lacunar infarctions documented on brain MRI scans in patients with first-ever lacunar stroke was associated with mild neuropsychological abnormalities, particularly in the performance of executive functions (semantic fluency) and short delayed verbal memory. According to these findings, in the initial stages of small vessel disease, mild neuropsychological abnormalities appear to be related to lacunes rather than to leukoaraiosis or perivascular hyperintensities of vascular cause.
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Affiliation(s)
| | - Adrià Arboix
- Cerebrovascular Division, Department of Neurology, Capio-Hospital Universitari del Sagrat Cor, Universitat de Barcelona, C/ Viladomat 288, E-08029, Barcelona, Catalonia, Spain.
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