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Liu D, Li N, Zhu Y, Chen Q, Feng J. Asymmetric U-shaped relationship between blood glucose and white matter lesions: results of a cross-sectional study. BMC Neurol 2025; 25:65. [PMID: 39953442 PMCID: PMC11827292 DOI: 10.1186/s12883-025-04077-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/07/2025] [Indexed: 02/17/2025] Open
Abstract
BACKGROUND Elderly individuals are susceptible to the accrual of White Matter Lesions (WMLs), a subcategory of cerebral small-vessel disease. WMLs are strongly linked to an increased risk of strokes, intracerebral hemorrhages, and dementia. While the relationship between blood glucose levels and the development of WMLs has been investigated in previous studies, the findings remain inconsistent. Some evidence suggests that glucose dysregulation, including both hypo- and hyperglycemia, may contribute to WML formation through mechanisms such as endothelial dysfunction and chronic inflammation. However, other studies report no significant correlation. This inconsistency underscores the need for further investigation. METHODS In this investigation, the primary data were derived from a predictive mathematical model designed to estimate WMLs based on parameters obtained from routine medical examinations, with head MRI scans serving as the reference standard for WML diagnosis and quantification. We leveraged multivariable logistic regression analysis to scrutinize the relationship between blood glucose concentrations and WMLs. Additionally, we employed a restricted cubic spline regression model to investigate a potential non-linear relationship between these variables. RESULTS There were 1904 participants who underwent medical check-ups which included a head MRI. Generally, the relationship between blood glucose levels and white matter lesions followed an asymmetric U-shaped curve (P for non-linearity = 0.004). A consistent finding was that compared to the individuals in the 2nd and 3rd quartiles (95 to 107 mg/dl), the 1st quartile (OR, 1.71; 95% CI: 1.26-2.30) and 4th quartile (OR, 1.57; 95%CI: 1.12-2.20) had white matter lesions were significantly higher. CONCLUSION An asymmetric U-shaped relationship exists between blood glucose and WMLs, with the lowest risk occurring at 95-107 mg/dl. Management of blood glucose can help prevent the occurrence and development of WMLs. However, the study's cross-sectional design limits causal inference, and the reliance on pre-existing data constrained the availability of variables.
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Affiliation(s)
- Dayuan Liu
- Department of Neurosurgery, The Second Affiliated Hospital of Hainan Medical University, 368 Yehai Avenue, Longhua District, Haikou City, Hainan Province, 570311, China
| | - Ning Li
- Department of Neurosurgery, The Second Affiliated Hospital of Hainan Medical University, 368 Yehai Avenue, Longhua District, Haikou City, Hainan Province, 570311, China
| | - Yubo Zhu
- Department of Neurosurgery, The Second Affiliated Hospital of Hainan Medical University, 368 Yehai Avenue, Longhua District, Haikou City, Hainan Province, 570311, China
| | - Qianhua Chen
- Hainan Medical University, No.3 Xueyuan Road, Longhua District, Haikou City, Hainan Province, 571199, China
| | - Jigao Feng
- Department of Neurosurgery, The Second Affiliated Hospital of Hainan Medical University, 368 Yehai Avenue, Longhua District, Haikou City, Hainan Province, 570311, China.
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Purroy F, Gallego Y, Gil-Villar MP, Begue R, Arque G, Quilez A, Sanahuja J, Vazquez-Justes D, Mauri G. Short- and Long-Term Prognoses After Tissue-Negative Transient Ischemic Attack. Stroke 2025; 56:56-64. [PMID: 39633566 DOI: 10.1161/strokeaha.124.048222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 10/11/2024] [Accepted: 10/30/2024] [Indexed: 12/07/2024]
Abstract
BACKGROUND The tissue-based definition of transient ischemic attack, which requires the use of diffusion-weighted imaging (DWI), has limitations in its applicability to clinical practice. This contributes to the limited evidence regarding the risk of subsequent stroke and the associated predictors in the group of patients who are tissue-negative on DWI. Our aim was to assess the early and long-term prognoses of consecutive patients with tissue-negative transient ischemic attacks attended at an emergency department. METHODS We performed a prospective cohort study of consecutive patients with neurologist-confirmed transient ischemic attack who were DWI-negative from January 2006 to June 2010. All patients underwent DWI on magnetic resonance imaging (4.0 [SD, 1.8] days) after the index event. The risk and predictors of stroke recurrence (SR) were determined at 1 year and after a median follow-up time of 6.6 (interquartile range, 5.0-9.6) years. RESULTS A total of 370 patients were included. Previously, 244 patients with positive DWI results and 109 patients without magnetic resonance imaging performed were excluded. ABCD2 score >5 was determined in 95 (26.2%) patients; 15 (4.1%) patients experienced SR at 1 year and 18 (4.9%) beyond 1 year. Predictive models for short- and long-term prognoses were different. Large artery atherosclerosis cause (hazard ratio, 3.7 [95% CI, 1.2-11.0]) was the only predictor of 1-year SR. In contrast, male sex (hazard ratio, 4.17 [95% CI, 1.14-15.23]; P=0.031), speech impairment (hazard ratio, 4.90 [95% CI, 1.05-22.93]; P=0.044), and the presence of chronic microangiopathy expressed as Fazekas score of 3 (hazard ratio, 1.84 [95% CI, 1.15-2.97]; P=0.012) were predictors of long-term SR follow-up. CONCLUSIONS Patients with DWI-negative have a clinically important risk of recurrent vascular events and SR during medium- and long-term follow-ups. These patients warrant optimized secondary prevention to reduce their risk of recurrent vascular events over time. Predictors of SR varied over the follow-up.
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Affiliation(s)
- Francisco Purroy
- Department of Neurology (F.P., Y.G., M.P.G.-V., A.Q., J.S., D.V.-J., G.M.), Stroke Unit, Hospital Universitari Arnau de Vilanova de Lleida, Spain
- Department of Medicine, Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida, Universitat de Lleida, Spain (F.P., Y.G., M.P.G.-V., G.A., A.Q., J.S., D.V.-J., G.M.)
| | - Yhovany Gallego
- Department of Neurology (F.P., Y.G., M.P.G.-V., A.Q., J.S., D.V.-J., G.M.), Stroke Unit, Hospital Universitari Arnau de Vilanova de Lleida, Spain
- Department of Medicine, Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida, Universitat de Lleida, Spain (F.P., Y.G., M.P.G.-V., G.A., A.Q., J.S., D.V.-J., G.M.)
| | - M Pilar Gil-Villar
- Department of Neurology (F.P., Y.G., M.P.G.-V., A.Q., J.S., D.V.-J., G.M.), Stroke Unit, Hospital Universitari Arnau de Vilanova de Lleida, Spain
- Department of Medicine, Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida, Universitat de Lleida, Spain (F.P., Y.G., M.P.G.-V., G.A., A.Q., J.S., D.V.-J., G.M.)
| | - Robert Begue
- Department of Radiology (R.B.), Stroke Unit, Hospital Universitari Arnau de Vilanova de Lleida, Spain
| | - Gloria Arque
- Department of Medicine, Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida, Universitat de Lleida, Spain (F.P., Y.G., M.P.G.-V., G.A., A.Q., J.S., D.V.-J., G.M.)
| | - Alejandro Quilez
- Department of Neurology (F.P., Y.G., M.P.G.-V., A.Q., J.S., D.V.-J., G.M.), Stroke Unit, Hospital Universitari Arnau de Vilanova de Lleida, Spain
- Department of Medicine, Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida, Universitat de Lleida, Spain (F.P., Y.G., M.P.G.-V., G.A., A.Q., J.S., D.V.-J., G.M.)
| | - Jordi Sanahuja
- Department of Neurology (F.P., Y.G., M.P.G.-V., A.Q., J.S., D.V.-J., G.M.), Stroke Unit, Hospital Universitari Arnau de Vilanova de Lleida, Spain
- Department of Medicine, Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida, Universitat de Lleida, Spain (F.P., Y.G., M.P.G.-V., G.A., A.Q., J.S., D.V.-J., G.M.)
| | - Daniel Vazquez-Justes
- Department of Neurology (F.P., Y.G., M.P.G.-V., A.Q., J.S., D.V.-J., G.M.), Stroke Unit, Hospital Universitari Arnau de Vilanova de Lleida, Spain
- Department of Medicine, Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida, Universitat de Lleida, Spain (F.P., Y.G., M.P.G.-V., G.A., A.Q., J.S., D.V.-J., G.M.)
| | - Gerard Mauri
- Department of Neurology (F.P., Y.G., M.P.G.-V., A.Q., J.S., D.V.-J., G.M.), Stroke Unit, Hospital Universitari Arnau de Vilanova de Lleida, Spain
- Department of Medicine, Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida, Universitat de Lleida, Spain (F.P., Y.G., M.P.G.-V., G.A., A.Q., J.S., D.V.-J., G.M.)
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Dimaras T, Merkouris E, Tsiptsios D, Christidi F, Sousanidou A, Orgianelis I, Polatidou E, Kamenidis I, Karatzetzou S, Gkantzios A, Ntatsis C, Kokkotis C, Retsidou S, Aristidou M, Karageorgopoulou M, Psatha EA, Aggelousis N, Vadikolias K. Leukoaraiosis as a Promising Biomarker of Stroke Recurrence among Stroke Survivors: A Systematic Review. Neurol Int 2023; 15:994-1013. [PMID: 37606397 PMCID: PMC10443317 DOI: 10.3390/neurolint15030064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 08/23/2023] Open
Abstract
Stroke is the leading cause of functional disability worldwide, with increasing prevalence in adults. Given the considerable negative impact on patients' quality of life and the financial burden on their families and society, it is essential to provide stroke survivors with a timely and reliable prognosis of stroke recurrence. Leukoaraiosis (LA) is a common neuroimaging feature of cerebral small-vessel disease. By researching the literature of two different databases (MEDLINE and Scopus), the present study aims to review all relevant studies from the last decade, dealing with the clinical utility of pre-existing LA as a prognostic factor for stroke recurrence in stroke survivors. Nineteen full-text articles published in English were identified and included in the present review, with data collected from a total of 34,546 stroke patients. A higher rate of extended LA was strongly associated with stroke recurrence in all stroke subtypes, even after adjustment for clinical risk factors. In particular, patients with ischemic stroke or transient ischemic attack with advanced LA had a significantly higher risk of future ischemic stroke, whereas patients with previous intracerebral hemorrhage and severe LA had a more than 2.5-fold increased risk of recurrent ischemic stroke and a more than 30-fold increased risk of hemorrhagic stroke. Finally, in patients receiving anticoagulant treatment for AF, the presence of LA was associated with an increased risk of recurrent ischemic stroke and intracranial hemorrhage. Because of this valuable predictive information, evaluating LA could significantly expand our knowledge of stroke patients and thereby improve overall stroke care.
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Affiliation(s)
- Theofanis Dimaras
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
| | - Ermis Merkouris
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
| | - Dimitrios Tsiptsios
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
| | - Foteini Christidi
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
| | - Anastasia Sousanidou
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
| | - Ilias Orgianelis
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
| | - Efthymia Polatidou
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
| | - Iordanis Kamenidis
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
| | - Stella Karatzetzou
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
| | - Aimilios Gkantzios
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
| | - Christos Ntatsis
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
| | - Christos Kokkotis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (C.K.); (M.A.); (M.K.); (N.A.)
| | - Sofia Retsidou
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
| | - Maria Aristidou
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (C.K.); (M.A.); (M.K.); (N.A.)
| | - Maria Karageorgopoulou
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (C.K.); (M.A.); (M.K.); (N.A.)
| | - Evlampia A. Psatha
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (C.K.); (M.A.); (M.K.); (N.A.)
| | - Konstantinos Vadikolias
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
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Wei D, Wang Y, Yang X, Jin L. Association of white mater lesions with orthostatic hypotension. Am J Transl Res 2022; 14:2410-2418. [PMID: 35559373 PMCID: PMC9091130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/09/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To reveal the cerebral hypoperperfusion characteristics of White matter lesions (WMLs), we monitored the blood pressure (BP) fluctuation in patients with orthostatic hypotension (OH) and WMLs. METHODS A total of 2265 syncope patients were enrolled in this retrospective study. Clinical outcomes of brain MRI or CT, tilt test and continuous electrocardiogram monitoring were reviewed. All patients were divided into two groups according to WMLs status, and the WMLs group was further classified into three subgroups according to Fazekas grade (1-3). BP fluctuation in these subgroups was compared. The risk factors of WMLs and OH were determined by a multivariate logistic regression test. RESULTS A total of 2265 syncope patients were enrolled, among which 56% patients were male. The average age of patients with WMLs was (61±12) years old. ΔTIME (Odds ratio [OR]: 1.014, 95% confidence interval [CI]: (1.005, 1.023), P=0.0015) and ΔSBP1 (OR: 0.990, 95% CI: (0.980, 1.000), P=0.0579) were demonstrated to be the risk factors of WMLs. The number of cases of repeated drops in blood pressure was twice as high as the cases with only drop in BP . The median and mean ΔSBP and ΔTIME of patients with WMLs were higher than those without WMLs. The incidence of diabetes, hypertension, age and Parkinson Plus Syndromes in patients with WMLs significantly decreased in comparison to those without WMLs (OR-diabetes: 2.558, OR-hypertension: 1.713, OR-age: 0.924 and OR-Parkinson Plus Syndromes: 0.476, P<0.05). CONCLUSION WMLs occurs in patients with hypoperfusion of recurrent OH. Vascular WMLs is associated with diabetes, hypertension, and age is at higher risk than WMLs associated with Parkinson Plus Syndromes.
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Affiliation(s)
- Dongmei Wei
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical UniversityBeijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical UniversityBeijing, China
- China National Clinical Research Center for Neurological DiseasesBeijing, China
| | - Xinchun Yang
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical UniversityBeijing, China
| | - Lina Jin
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical UniversityBeijing, China
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Epstein A, Schilter M, Vynckier J, Kaesmacher J, Mujanovic A, Scutelnic A, Beyeler M, Belachew NF, Grunder L, Arnold M, Seiffge DJ, Jung S, Fischer U, Meinel TR. Chronic Covert Brain Infarctions and White Matter Hyperintensities in Patients With Stroke, Transient Ischemic Attack, and Stroke Mimic. J Am Heart Assoc 2022; 11:e024191. [PMID: 35043677 PMCID: PMC9238476 DOI: 10.1161/jaha.121.024191] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background This study was conducted to compare frequencies of chronic brain infarctions (CBIs) and white matter hyperintensities (WMHs) as well as their associations with established early recurrence risk scores in patients with transient ischemic attack (TIA) and stroke mimics compared with ischemic stroke. Methods and Results Single‐center cohort study including consecutive patients with TIA, stroke mimics, and acute ischemic stroke, with available magnetic resonance imaging from January 2015 to December 2017. Blinded raters adjudicated WMH (age‐related white matter changes score) and CBI according to established definitions. A total of 2112 patients (median [Q1–Q3] age 71 [59–80] years, 43% women, National Institutes of Health Stroke Scale score of 2 [1–7], 80% ischemic stroke, 18% TIA, 2% stroke mimics) were included. While CBIs were present in only 10% of patients with stroke mimic, they were detected in 28% of TIAs and 38% of ischemic strokes (P<0.001). WMHs were less pronounced (0, 0–1) in patients with stroke mimic, but there was no difference between TIA (1, 1–2) and ischemic stroke (0, 1–2) patients. CBIs (adjusted odds ratio, 0.3; 95% CI, 0.1–0.9) were associated with a lower rate of stroke mimic as the final diagnosis, while WMHs were not (adjusted odds ratio per point, 1.3; 95% CI, 0.7–2.2). WMH (β per point, 0.4; 95% CI, 0.3–0.6) and presence of CBI (β, 0.6; 95% CI, 0.3–0.9) were associated with a higher cardiovascular risk profile according to the ABCD3‐I score. The accuracy of prediction was good for high‐risk TIA (cross‐validated area under the receiver operating characteristic curve, 0.89; 95% CI, 0.79–0.93) on the basis of brain imaging, age, and sex. Conclusions CBI and WMH differ between patients with stroke mimic and patients with TIA/ischemic stroke and are closely associated with established recurrence risk scores. Prospective studies need to clarify whether including brain frailty markers may contribute to the refinement of current management algorithms and risk stratifications.
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Affiliation(s)
- Alessandra Epstein
- Department of Neurology Inselspital Bern University Hospital, and University of Bern Switzerland
| | - Marina Schilter
- Department of Neurology Inselspital Bern University Hospital, and University of Bern Switzerland
| | - Jan Vynckier
- Department of Neurology Inselspital Bern University Hospital, and University of Bern Switzerland
| | - Johannes Kaesmacher
- University Institute for Diagnostic and Interventional Neuroradiology Inselspital Bern University Hospital, and University of Bern Switzerland.,University Institute for Diagnostic and Interventional Radiology Inselspital Bern University Hospital, and University of Bern Switzerland
| | - Adnan Mujanovic
- Department of Neurology Inselspital Bern University Hospital, and University of Bern Switzerland.,University Institute for Diagnostic and Interventional Neuroradiology Inselspital Bern University Hospital, and University of Bern Switzerland
| | - Adrian Scutelnic
- Department of Neurology Inselspital Bern University Hospital, and University of Bern Switzerland
| | - Morin Beyeler
- Department of Neurology Inselspital Bern University Hospital, and University of Bern Switzerland
| | - Nebiyat Filate Belachew
- University Institute for Diagnostic and Interventional Neuroradiology Inselspital Bern University Hospital, and University of Bern Switzerland
| | - Lorenz Grunder
- University Institute for Diagnostic and Interventional Radiology Inselspital Bern University Hospital, and University of Bern Switzerland
| | - Marcel Arnold
- Department of Neurology Inselspital Bern University Hospital, and University of Bern Switzerland
| | - David Julian Seiffge
- Department of Neurology Inselspital Bern University Hospital, and University of Bern Switzerland
| | - Simon Jung
- Department of Neurology Inselspital Bern University Hospital, and University of Bern Switzerland
| | - Urs Fischer
- Department of Neurology Inselspital Bern University Hospital, and University of Bern Switzerland
| | - Thomas Raphael Meinel
- Department of Neurology Inselspital Bern University Hospital, and University of Bern Switzerland
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High burden of cerebral white matter lesion in 9 Asian cities. Sci Rep 2021; 11:11587. [PMID: 34078946 PMCID: PMC8172636 DOI: 10.1038/s41598-021-90746-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/13/2021] [Indexed: 12/19/2022] Open
Abstract
Age-related white matter lesion (WML) is considered a manifestation of sporadic cerebral small vessel disease and an important pathological substrate for dementia. Asia is notable for its large population with a looming dementia epidemic. Yet, the burden of WML and its associated risk factors across different Asian societies are unknown. Subjects from 9 Asian cities (Bangkok, Bandung, Beijing, Bengaluru, Hong Kong, Kaohsiung, Manila, Seoul, and Singapore) were recruited (n = 5701) and classified into (i) stroke/transient ischemic attack (TIA), (ii) Alzheimer's disease (AD)/mild cognitive impairment (MCI), or (iii) control groups. Data on vascular risk factors and cognitive performance were collected. The severity of WML was visually rated on MRI or CT. The prevalence of moderate-to-severe WML was the highest in subjects with stroke/TIA (43.3%). Bandung Indonesia showed the highest prevalence of WML, adjusted for age, sex, education, disease groups, and imaging modality. Hypertension and hyperlipidemia were significant risk factors for WML, and WML was negatively associated with MMSE in all groups. WML is highly prevalent in Asia and is associated with increasing age, hypertension, hyperlipidemia, and worse cognitive performance. Concerted efforts to prevent WML will alleviate the huge dementia burden in the rapidly aging Asian societies.
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Associations between Lesion Locations and Stroke Recurrence in Survivors of First-ever Ischemic Stroke: A Prospective Cohort Study. Curr Med Sci 2020; 40:708-718. [PMID: 32862382 DOI: 10.1007/s11596-020-2240-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 05/14/2020] [Indexed: 02/05/2023]
Abstract
Several studies have indicated that stroke survivors with multiple lesions or with larger lesion volumes have a higher risk of stroke recurrence. However, the relationship between lesion locations and stroke recurrence is unclear. We conducted a prospective cohort study of first-ever ischemic stroke survivors who were consecutively enrolled from January 2010 to December 2015. Stroke recurrence was assessed every 3 months after post-discharge via telephone interviews by trained interviewers. Lesion locations were obtained from hospital-based MRI or CT scans and classified using two classification systems that were based on cerebral hemisphere or vascular territory and brain anatomical structures. Flexible parametric survival models using the proportional hazards scale (PH model) were used to analyze the time-to-event data. Among 633 survivors, 63.51% (n=402) had anterior circulation ischemia (ACI), and more than half of all ACIs occurred in the subcortex. After a median follow-up of 2.5 years, 117 (18.48%) survivors developed a recurrent stroke. The results of the multivariate PH model showed that survivors with non-brain lesions were at higher risk of recurrence than those with right-side lesions (HR, 2.79; 95%CI, 1.53, 5.08; P=0.001). There was no increase in risk among survivors with left-side lesions (HR, 0.97; 95%CI, 0.53, 1.75; P=0.914) or both-side lesions (HR, 1.24; 95%CI, 0.75, 2.07; P=0.401) compared to those with right-side lesions. Additionally, there were no associations between stroke recurrence and lesion locations that were classified based on vascular territory and brain anatomical structures. It was concluded that first-ever ischemic stroke survivors with non-brain lesion had higher recurrence risk than those with right-side lesion, although no significant associations were found when the lesion locations were classified by vascular territory and brain anatomical structures.
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