Leukoaraiosis in Stroke Patients

Abstract

Pathogenesis of leukoaraiosis (LA) is not clearly understood and its significance in patients with stroke remains undetermined. In the Neurology Department of Ankara Hospital, computed tomography (CT) examination of brain was performed for various reasons in 288 patients. LA was detected in 178 patients by the use of brain CT. Patients with LA had a higher incidence of hypertension history (70.8%) when compared with the non-LA group (57.3%; p <.05). There was no statistically significant difference in terms of sex, mean age, smoking, diabetes mellitus, history of cerebrovascular disease, cardiac failure, ischemic cardiac disease between patients with and without LA. We showed that LA is related to hypertension but not related to age, diabetes mellitus, or cardiac disease in our patient population.

Brain Lesions on MRI in Elderly Patients with Type 2 Diabetes Mellitus

“…In contrast, the Scheltens scale, which was used in the present study, is able to detect small amounts of WML [15]. Furthermore, other studies were not designed to specifically assess the effects of DM on neuro-imaging modalities but assessed the effect of DM in selected patients with stroke or other cardiovascular risk factors [2, 5, 7, 9]. The results of these studies have low external validity and do not allow to generalize to the DM population visiting an out-patient clinic.…”

“…Two population-based studies demonstrated a relation of DM with cerebral atrophy, whereas an association with WML was not found [3, 6]. Most other studies used dichotomous or ordinal rating scales, which may be not sensitive enough in the discrimination between various degrees of WML [2,7,8,9,10]. This might be important, because the consistently reported modest cognitive deficits in DM patients do not suggest severe lesions and the used scales may therefore underestimate WML in DM patients [1].…”

“…The exact cerebral mechanisms underlying these cognitive deficits remain unclear but brain atrophy and vascular changes have both been assumed. Although a significant relation between DM and cortical or subcortical atrophy has been found in several studies, the results with regard to the relation of DM and white matter lesions (WML) or lacunar infarcts are conflicting [2,3,4,5,6,7,8,9,10]. Reasons for these inconsistencies are methodological problems, like the number of patients studied, the use of insensitive rating scales to assess WML and patient selection.…”

“…Reasons for these inconsistencies are methodological problems, like the number of patients studied, the use of insensitive rating scales to assess WML and patient selection. Moreover, most studies were not specifically designed to assess the effects of DM on structural brain lesions but were performed in a group of selected patients who already suffered from a stroke [2, 5, 7, 9]. In addition, a distinction into type 1 or type 2 DM was usually not made in most studies, while they may have different effects on the brain.…”

Brain Imaging in Patients With Diabetes

“…From the 46 articles, 3 study populations included only type 1 diabetic patients, 2 included only type 2 diabetes, 32 were classified as "predominantly type 2 diabetes," and 9 were classified as "diabetes of unknown type" (Tables 1-3). The diagnosis of diabetes was based on history or medication use in 20 studies (7,8,14,18,20,21,24,26,28,(31)(32)(33)(37)(38)(39)(40)(41)(42)(43)(44), while in the other studies, active screening was done by fasting glucose levels, random glucose levels, or an oral glucose tolerance test. Only two studies included data on metabolic control (16,36).…”