White matter hyperintensities in patients with multiple system atrophy

Abstract

Recent studies have reported that the majority of patients with multiple system atrophy (MSA) had hypertensive heart disease. However, the effect of autonomic failure on the brain in MSA has not been studied. We consecutively enrolled 63 patients with MSA and selected 63 age-and sex-matched healthy subjects. We performed a comparative analysis of cerebrovascular lesions between the patients with MSA and the control subjects and analyzed predisposing factors for cerebrovascular lesions in the patients with MSA. There was no significant difference in lacune and territorial infarcts between the patients with MSA and the control subjects. The median grading score of white matter hyperintensity (WMH) was significantly higher in the patients with MSA (1.0, interquartile range 0.5-2.0) than the control subjects (0.0, interquartile range 0.0-1.0; P \ 0.01). In the patients with MSA, there was strong correlation between the grading score of WMH and supine systolic blood pressure (r = 0.529, P \ 0.001) after adjusting for age. Multiple linear regression analysis showed that age and supine systolic blood pressure was significantly and independently correlated with the grading score of WMH. The present study demonstrates that patients with MSA had more severe WMH and that supine systolic pressure is a major contributing factor for the severity of WMH, suggesting that patients with MSA have target-organ damage of the brain.

Orthostatic and Supine Blood Pressures Are Associated with White Matter Hyperintensities in Parkinson Disease

“…Recent investigations in patients with multiple system atrophy indicate that supine systolic blood pressure and/or blood pressure changes during orthostasis are significantly and independently correlated with WMH 17,18. However, a similar phenomenon was not confirmed in patients with PD 18.…”

A comparative analysis of cognitive profiles and white-matter alterations using voxel-based diffusion tensor imaging between patients with Parkinson's disease dementia and dementia with Lewy bodies

“…This WHM score was determined by grading the extent of increased white-matter signal intensity on the fluid-attenuated inversion recovery sequence images in the periventricular and subcortical white-matter area. The grading was based on a 10-point scale (0 to 9), with a higher score indicating a more severe white-matter grade 18 19. Possible medical comorbidities were also excluded by laboratory tests, including a thyroid function test, vitamin B 12 and folic acid levels, and a VDRL test.…”

Syncope and orthostatic intolerance increase risk of brain lesions in migraineurs and controls

“…19,20 An increased rate of WMLs has also been reported in patients with severe, symptomatic OH due to multiple system atrophy and Lewy body dementia. [21][22][23] The severity of OH correlated with the degree of WMLs. A multifactorial etiology for WMLs is likely because OH often occurs together with known WML risk factors, including supine hypertension and cognitive decline.…”