Do Lacunar Infarcts Have Different Aetiologies? Risk Factor Profiles of Lacunar Infarcts in Deep White Matter and Basal Ganglia: The Second Manifestations of ARTerial Disease-Magnetic Resonance Study

Kloppenborg, Raoul P.; Nederkoorn, Paul J.; Grool, Anne M.; Cocker, Laurens J L De; Mali, Wptm; Graaf, Yolanda van der; Geerlings, Mirjam I.

doi:10.1159/000454782

Cited by 15 publications

(13 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, hyperhomocysteinemia has been associated an increased risk of LI in the BG, and hyperlipidemia always leads to isolated LI in the deep gray nuclei/internal capsule. [ 40 41 ] In patients with diabetes, LI is more frequently caused by branch orifice atheromatous disease than hypertensive arteriopathy, the latter of which is the predominant vascular pathology underlying strictly deep/mixed CMB. [ 42 ]…”

Section: Acunar I Nfarctmentioning

confidence: 99%

Hypertension-Induced Cerebral Small Vessel Disease Leading to Cognitive Impairment

Yang

Dong

Lyu

et al. 2018

Chinese Medical Journal

View full text Add to dashboard Cite

Objective:Alzheimer's disease and vascular dementia are responsible for more than 80% of dementia cases. These two conditions share common risk factors including hypertension. Cerebral small vessel disease (CSVD) is strongly associated with both hypertension and cognitive impairment. In this review, we identify the pathophysiological changes in CSVD that are caused by hypertension and further explore the relationship between CSVD and cognitive impairment.Data Sources:We searched and scanned the PubMed database for recently published literatures up to December 2017. We used the keywords of “hypertension”, “cerebral small vessel disease”, “white matter lesions”, “enlarged perivascular spaces”, “lacunar infarcts”, “cerebral microbleeds”, and “cognitive impairment” in the database of PubMed.Study Selection:Articles were obtained and reviewed to analyze the hypertension-induced pathophysiological changes that occur in CSVD and the correlation between CSVD and cognitive impairment.Results:In recent years, studies have demonstrated that hypertension-related changes (e.g., small vascular lesions, inflammatory reactions, hypoperfusion, oxidative stress, damage to autoregulatory processes and the blood-brain barrier, and cerebral amyloid angiopathy) can occur over time in cerebral small vessels, potentially leading to lower cognitive function when blood pressure (BP) control is poor or lacking. Both isolated and co-occurrent CSVD can lead to cognitive deterioration, and this effect may be attributable to a dysfunction in either the cholinergic system or the functionality of cortical and subcortical tracts.Conclusions:We explore the currently available evidence about the hypertensive vasculopathy and inflammatory changes that occur in CSVD. Both are vital prognostic indicators of the development of cognitive impairment. Future studies should be performed to validate the relationship between BP levels and CSVD progression and between the numbers, volumes, and anatomical locations of CSVD and cognitive impairment.

show abstract

Section: Acunar I Nfarctmentioning

confidence: 99%

Hypertension-Induced Cerebral Small Vessel Disease Leading to Cognitive Impairment

Yang

Dong

Lyu

et al. 2018

Chinese Medical Journal

View full text Add to dashboard Cite

show abstract

“…In addition, we find that patients with subcortical white matter RSSIs have a severe burden of WMH, and the RSSIs also more frequently contact with surrounding WMH compared to brainstem and basal ganglia region RSSIs. These findings can be explained by the shared risk factors of RSSIs and WMH ( Inzitari, 2003 ; Bailey et al, 2012 ; Traylor et al, 2016 ) and also evidence showing that WMH is associated with the occurrence of subcortical white matter RSSIs, independent of age and vascular risk factors, such as hypertension and diabetes ( Kloppenborg et al, 2017 ; Pinter et al, 2018 ; Xu et al, 2018 ).…”

Section: Discussionmentioning

confidence: 91%

“…RSSIs can occur in three locations, including the brainstem, subcortical white matter, and basal ganglia region. Previous studies find that RSSIs in different locations could have different etiologies (Nah et al, 2010;Kloppenborg et al, 2017;Eppinger et al, 2019), and their association with vascular risk factors and concomitant cerebrovascular conditions also varies (Gouw et al, 2008;Del Bene et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Factors Associated With the Occurrence and Evolution of Recent Small Subcortical Infarcts (RSSIs) in Different Locations

Hong

Zhang

et al. 2020

Front. Aging Neurosci.

View full text Add to dashboard Cite

Recent small subcortical infarcts (RSSIs) can occur in different brain regions. Distinct etiologies might be involved for RSSIs in different locations and could further affect RSSI cavitation and functional outcomes. In this study, we aim to analyze the baseline clinical and imaging characteristics associated with the occurrence and cavitation of RSSIs in different locations. We retrospectively include patients who presented with RSSIs from a database for cerebral small vessel disease. Detailed information, including demographic, clinical, laboratory, and radiological data, were collected. We identify baseline RSSIs on diffusion-weighted images and divide them into brainstem, subcortical white matter, and basal ganglia region groups. Cavitation is evaluated on follow-up T2 fluid-attenuated inversion recovery (FLAIR) images. Statistical analysis is performed to determine factors associated with the occurrence and cavitation of RSSIs in different locations. We find that patients with brainstem RSSIs have a higher proportion of diabetes (64.1%) compared to patients with subcortical white matter (27.3%, P < 0.001) and basal ganglia region RSSIs (35.2%, P = 0.006) and have higher levels of HbA1c (7.20%) compared to patients with subcortical white matter (6.10%, P = 0.001) and basal ganglia region RSSIs (6.20%, P = 0.003). In addition, patients with brainstem RSSIs have higher NIHSS scores than patients with subcortical white matter RSSIs (2 vs 0, P = 0.001). Patients with subcortical white matter RSSIs have higher a white matter hyperintensity (WMH) burden compared to patients with basal ganglia region RSSIs (21.64 cm 3 vs 11.10 cm 3 , P = 0.004). Follow-up analysis demonstrates that basal ganglia region RSSIs are less likely to cavitate than subcortical white matter RSSIs (61.4% vs 83.6%, P = 0.010), and contacting with WMH is associated with the cavitation of subcortical white matter RSSIs (OR: 101.760, P = 0.003). Our study demonstrates that RSSIs in different locations are associated with different clinical and imaging characteristics. Furthermore, cavitation of RSSIs might be affected by local lesion features and the surrounding environment rather than general demographic and clinical factors.

show abstract

“…2A). Lacunar infarcts of basal ganglia as well as white matter T2 hyperintensities presumably have vascular origin, and represent cerebral small vessel ischemic disease (Kloppenborg et al, 2017). It has been suggested that lacunar infarcts in the deep white matter are due to arteriolosclerosis or endothelial damage; whereas, lacunar infarcts in the basal ganglia represent thrombo-embolic occlusion of perforating arteries (Wardlaw et al, 2013a; Wardlaw et al, 2013b).…”

Section: Discussionmentioning

confidence: 99%

Stroke atlas of the brain: Voxel-wise density-based clustering of infarct lesions topographic distribution

Wang

Juliano

Liew

et al. 2019

NeuroImage: Clinical

View full text Add to dashboard Cite

Objective The supply territories of main cerebral arteries are predominantly identified based on distribution of infarct lesions in patients with large arterial occlusion; whereas, there is no consensus atlas regarding the supply territories of smaller end-arteries. In this study, we applied a data-driven approach to construct a stroke atlas of the brain using hierarchical density clustering in large number of infarct lesions, assuming that voxels/regions supplied by a common end-artery tend to infarct together. Methods A total of 793 infarct lesions on MRI scans of 458 patients were segmented and coregistered to MNI-152 standard brain space. Applying a voxel-wise data-driven hierarchical density clustering algorithm, we identified those voxels that were most likely to be part of same infarct lesions in our dataset. A step-wise clustering scheme was applied, where the clustering threshold was gradually decreased to form the first 20 mother (>50 cm 3 ) or main (1–50 cm 3 ) clusters in addition to any possible number of tiny clusters (<1 cm 3 ); and then, any resultant mother clusters were iteratively subdivided using the same scheme. Also, in a randomly selected 2/3 subset of our cohort, a bootstrapping cluster analysis with 100 permutations was performed to assess the statistical robustness of proposed clusters. Results Approximately 91% of the MNI-152 brain mask was covered by 793 infarct lesions across patients. The covered area of brain was parcellated into 4 mother, 16 main, and 123 tiny clusters at the first hierarchy level. Upon iterative clustering subdivision of mother clusters, the brain tissue was eventually parcellated into 1 mother cluster (62.6 cm 3 ), 181 main clusters (total volume 1107.3 cm 3 ), and 917 tiny clusters (total volume of 264.8 cm 3 ). In bootstrap analysis, only 0.12% of voxels, were labelled as “unstable” – with a greater reachability distance in cluster scheme compared to their corresponding mean bootstrapped reachability distance. On visual assessment, the mother/main clusters were formed along supply territories of main cerebral arteries at initial hierarchical levels, and then tiny clusters emerged in deep white matter and gray matter nuclei prone to small vessel ischemic infarcts. Conclusions Applying voxel-wise data-driven hierarchical density clustering on a large number of infarct lesions, we have parcellated the brain tissue into clusters of voxels that tend to be part of same infarct lesion, and presumably representing end-arterial supply territories. This hierarchical stroke atlas of the brain is shared publicly, and can potentially be applied for future infarct location-outcome analysis.

show abstract

Do Lacunar Infarcts Have Different Aetiologies? Risk Factor Profiles of Lacunar Infarcts in Deep White Matter and Basal Ganglia: The Second Manifestations of ARTerial Disease-Magnetic Resonance Study

Cited by 15 publications

References 25 publications

Hypertension-Induced Cerebral Small Vessel Disease Leading to Cognitive Impairment

Hypertension-Induced Cerebral Small Vessel Disease Leading to Cognitive Impairment

Factors Associated With the Occurrence and Evolution of Recent Small Subcortical Infarcts (RSSIs) in Different Locations

Stroke atlas of the brain: Voxel-wise density-based clustering of infarct lesions topographic distribution

Contact Info

Product

Resources

About