Regional cerebral blood flow in lacunar infarction

The contribution of oral infectious diseases in lacunar stroke based on meta-analysis and Mendelian randomization study

To investigate the causal relationship between oral infectious diseases and lacunar stroke (LS) and to identify the role of interleukin-1α (IL-1α), interleukin-6 (IL-6), tumor necrosis factor (TNF), and C-reaction protein (CRP) as potential mediators. The meta-analysis incorporating cross-sectional studies was carried out. Additionally, two-sample Mendelian randomization (MR) analysis was performed to explore the associations between genetically predicted oral infectious diseases (including dental caries, periodontitis, and pulp and periapical diseases) and lacunar stroke, utilizing summary-level data from genome-wide association studies (GWAS). This was followed by a mediation analysis to explore the role of IL-1α, IL-6, TNF, and CRP. Meta-analysis suggested that individuals with periodontitis have a 5.16 times higher risk of developing LS compared to those without periodontitis (95%CI 3.68-7.24). Genetically predicted pulp and periapical diseases (Odds ratios [OR]: 1.20, 95% CI 1.03-1.41) and periodontitis (OR: 1.24, 95%CI 1.03-1.49) showed a moderate association with LS. However, the mediation analysis yielded negative results. The evidence derived from both the MR study and the meta-analysis suggested a potential association between periodontitis and LS. These findings indicated that periodontitis might play a role in the development of LS. However, given the limitations inherent in our research, further studies are necessary to validate these conclusions.

Association between enlarged perivascular spaces in basal ganglia and cerebral perfusion in elderly people

Background and objective

Enlarged perivascular spaces in basal ganglia (BG-EPVS) are considered an imaging marker of cerebral small vessel disease (CSVD), but its pathogenesis and pathophysiological process remain unclear. While decreased cerebral perfusion is linked to other CSVD markers, the relationship between BG-EPVS and cerebral perfusion remains ambiguous. This study aimed to explore this association.

Methods

Elderly individuals with severe BG-EPVS (n = 77) and age/sex-matched controls (n = 89) underwent head CT perfusion imaging. The cerebral perfusion parameters including mean transit time (MTT), time to maximum (TMAX), cerebral blood flow (CBF), and cerebral blood volume (CBV) were quantitatively measured by symmetric regions of interest plotted in the basal ganglia region. Point-biserial correlation and logistics regression analysis were performed to investigate the association between BG-EPVS and cerebral perfusion.

Results

There were no significant differences in MTT, TMAX, or CBF between BG-EPVS group and control group. CBV was significantly lower in the BG-EPVS group (p = 0.035). Point-biserial correlation analysis showed a negative correlation between BG-EPVS and CBV (r = -0.198, p = 0.011). BG-EPVS group and control group as the dependent variable, binary logistics regression analysis showed that CBV was not an independent risk factor for severe BG-EPVS (p = 0.448). All enrolled patients were divided into four groups according to the interquartile interval of CBV. The ordered logistic regression analysis showed severe BG-EPVS was an independent risk factor for decreased CBV after adjusting for confounding factors (OR = 2.142, 95%CI: 1.211-3.788, p = 0.009).

Conclusion

Severe BG-EPVS is an independent risk factor for decreased CBV in the elderly, however, the formation of BG-EPVS is not solely dependent on changes in CBV in this region. This finding provides information about the pathophysiological consequence caused by severe BG-EPVS.

Risk assessment of lacunar infarct associated with oral conditions: A case control study focused on radiographic bone loss and Eichner classification

PURPOSE

This study aimed to evaluate whether lacunar infarcts can be predicted from occlusal support and periodontal stage on images.

METHODS

Seventy patients with lacunar infarcts and 300 participants without lacunar infarcts who underwent cerebral checkups at our university hospital were retrospectively reviewed. Lacunar infarcts were assessed using magnetic resonance images by a neuroradiologist. The number of teeth, occlusal support, and severity of radiographic bone loss (RBL) were evaluated using computed tomography. Occlusal support was classified according to the Eichner classification. Additionally, patient characteristics were investigated using medical charts and blood test reports. Records of clinical periodontal parameters, such as clinical attachment loss and bleeding on probing, were also evaluated.

RESULTS

The severity of RBL and Eichner classification in patients with lacunar infarcts was significantly higher than that in individuals without lacunar infarcts (P<.01). Receiver operating characteristic analysis revealed that the cut-off values for predicting lacunar infarct were ≥ III in the severity of RBL and ≥B1 in the Eichner classification. The corresponding areas under the curve were 0.75 and 0.70, respectively. In multivariate analysis, the factors affecting the severity of RBL (≥ III) (odds ratio [OR], 8.1; 95% confidence interval [CI], 4.1-16.3; P ‹.001), and Eichner classification ( ≥B1) (OR, 1.9; 95% CI, 0.86-4.1; P ‹.05) were significantly associated with the occurrence of lacun ar infarcts.

CONCLUSIONS

The severity of RBL and the Eichner classification may be helpful in predicting lacunar infarcts. Therefore, proper periodontal treatment and prosthodontic rehabilitation of missing teeth may prevent lacunar infarcts.

Cerebrovascular acetazolamide reactivity and platelet function in asymptomatic cerebral thrombosis

In order to find out the relationship between the cerebrovascular acetazolamide reactivity and platelet function in asymptomatic cerebral thrombosis, 10 cases of asymptomatic cerebral infarction and 10 age-matched control subjects were studied. The cerebrovascular acetazolamide reactivity was measured using xenon computed tomography method. As markers of platelet function, the plasma concentrations of platelet factor 4, beta-thromboglobulin, thromboxane B2, and 11-dehydrothromboxane B2 were determined. The cerebrovascular acetazolamide reactivity was significantly lower in the asymptomatic cerebral infarction group than in the control group. The plasma concentrations of platelet factor 4, beta-thromboglobulin, thromboxane B2, and 11-dehydrothromboxane B2 were higher in the asymptomatic cerebral infarction group than in the control group. There was a significant negative correlation between the cerebrovascular acetazolamide reactivity and the plasma concentrations of platelet factor 4, beta-thromboglobulin, thromboxane B2, and 11-dehydrothromboxane B2. The low cerebrovascular acetazolamide reactivity is considered to be related to platelet activation in asymptomatic cerebral thrombosis.

Differences in regional cerebral blood flow in two types of leuko-araiosis

Cerebral blood flow and cerebrovascular acetazolamide reactivity were investigated in patients with periventricular hyperintensity and in patients with leuko-araiosis in centrum semiovale. Fifteen patients with periventricular hyperintensity, 15 patients with leuko-araiosis in centrum semiovale and 15 age-matched controls without leuko-araiosis were studied. The regional cerebral blood flow was measured using the stable xenon CT method before and 20 min after intravenous injection of 17 mg/kg acetazolamide. The blood flow and the cerebrovascular acetazolamide reactivity in the area of leuko-araiosis were significantly lower in the periventricular hyperintensity group and the leuko-araiosis in centrum semiovale group than the control group. The blood flow in the cerebral cortex was significantly lower in the leuko-araiosis in centrum semiovale group than in the periventricular hyperintensity group and the control group. The cerebrovascular acetazolamide reactivity in the cerebral cortex did not show any significant difference among the three groups. The blood flow in the cerebral cortex was decreased in patients with leuko-araiosis in centrum semiovale but the cerebrovascular acetazolamide reactivity in the cerebral cortex was normal in patients with leuko-araiosis.

Cerebral blood flow in single and multiple lacunar infarctions

BACKGROUND AND PURPOSE

Single and multiple lacunar infarctions may have some difference in underlying diseases and cerebral blood flows. To determine the difference, we investigated underlying diseases and cerebral blood flows in single and multiple lacunar infarctions.

METHODS

Fifteen cases of lacunar infarction, 10 cases of multiple lacunar infarctions, and 16 control subjects were studied. Regional cerebral blood flow was measured within 14 days after stroke onset with the stable xenon CT method.

RESULTS

The rate of association of diabetes mellitus was higher in the multiple lacunar infarctions group than in the single lacunar infarction group. The blood flow in the cerebral cortex was significantly lower in the multiple lacunar infarctions group than in the single lacunar infarction group. The blood flow change by acetazolamide in the cerebral cortex was significantly lower in the multiple lacunar infarctions group than in the single lacunar infarction group.

CONCLUSIONS

There is some difference in underlying diseases and cerebral blood flows between single and multiple lacunar infarctions.