Periventricular white matter lucency and cerebral blood flow autoregulation in hypertensive patients.

Abstract

The goal of this study was to elucidate the association between the development of periventricular white matter lucency and autoregulation of cerebral blood flow in hypertensive patients through the arteriovenous oxygen saturation difference method. We studied 51 hypertensive patients who had previously suffered from minor strokes (lacunar infarction, 43; deep basal minor hemorrhage, 8). Patients were divided into three groups based on the findings of periventricular white matter lucency. We measured the absolute value of resting cerebral blood flow using the argon inhalation method, and stepwise reduction of blood pressure was obtained with patients on a tilting table. Intracerebral venous blood sampling was accomplished by direct cannulation into the jugular vein up to the jugular bulb. We calculated several cerebral circulatory parameters, such as cerebrovascular resistance and cerebral oxygen consumption, and also delineated individual C linicopathological studies suggest that arteriosclerosis resulting from the effects of chronic hypertension is related to the development of periventricular white matter lucency (PVL) or leukoaraiosis. 13 Clinical studies have indicated a connection between this radiological finding and neurological changes, Binswanger's disease in particular. -5Hypertension profoundly influences the autoregulation of cerebral blood flow (CBF) by shifting both lower and upper limits of autoregulatory range toward a higher blood pressure.6 " 8 This phenomenon has also been attributed to structural alterations in the small arteries related to hypertension.To our knowledge, a direct association between PVL and CBF autoregulation has not been investigated. We examined the relation between these two factors in patients with chronic hypertension to determine whether brain computed tomographic (CT) evidence of severe PVL was associated with impaired CBF autoregulation. MethodsWe studied 51 inpatients (34 men, 17 women; age range, 46 to 77 years; mean, 59.4±6.92 years) with chronic hypertension who had previously experienced some type of stroke (lacunar

Late-life depression, heart failure and frontal white matter hyperintensity: a structural magnetic resonance imaging study

“…The fact that our significant correlation was restricted to PV-WMH is consistent with studies on the general population that have related cardiovascular risk factors more consistently to PV-WMH (10,17). On the other hand, other studies of clinical samples have shown that D-WMH may contribute more significantly to the presence of depressive symptoms in patients with stroke (6).…”

NADPH Oxidase-Derived Reactive Oxygen Species Mediate the Cerebrovascular Dysfunction Induced by the Amyloid β Peptide

“…Another deleterious vascular effect of A␤ 1-40 is a disruption of cerebrovascular autoregulation (Niwa et al, 2002b), a mechanism in part mediated by vasoactive factors produced in endothelial cells, which prevents fall of CBF during hypotension Jones et al, 1999;Chillon and Baumbach, 2002). Failure of autoregulation leads to ischemic damage of cortical white matter (Matsushita et al, 1994), a finding that may be responsible for the white matter lesions observed in patients with AD (Brun and Englund, 1986;Van Dijk et al, 2004). These observations, collectively, suggest that A␤ peptides, in addition to their well known deleterious effects on neurons (Selkoe and Schenk, 2003), can also disrupt the function of cerebral blood vessels.…”

High Blood Pressure, Physical and Cognitive Function, and Risk of Stroke in the Oldest Old

“…4 Once advanced cerebrovascular damage is present, these mechanisms cannot effectively regulate level of cerebral blood flow. 5,6 Therefore, low systemic blood pressure in the presence of cerebrovascular damage may lead to decline in cerebral blood flow, which renders brain tissue vulnerable to ischemic events. 7 Both physical and cognitive impairment are common in very old age and are strongly associated with cerebrovascular pathologies and cerebral hypoperfusion.…”