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(Stroke. 1999;30:2053-2058.)
© 1999 American Heart Association, Inc.
Original Contributions |
Magnetic Resonance Imaging White Matter Hyperintensities and Mechanism of Ischemic Stroke
From the Department of Radiology (R.M., H.J.A., O.S., T. Peltonen, C-G.S-N.), Department of Clinical Neurosciences, Memory Research Unit (T. Pohjasvaara, T.E.), and Stroke Unit (M. Kaste), Helsinki University Central Hospital, and Department of Clinical Radiology, Kuopio University Hospital (H.J.A.), and Espoo-Vantaa Polytechnic, Hyvinkää Institute (M. Korpelainen) (Finland).
Background and Purpose—We sought to determine the relations between infarct subtype and white matter hyperintensities (WMHIs) on MRI.
Materials and Methods—We studied 395 ischemic stroke patients with 1.0-T MRI. The number of lacunar, border-zone, and cortical infarcts was registered. WMHIs were analyzed in 6 areas. Univariate and multivariate statistical analyses were used to find the risk factors for different infarct subtypes and to study the connections between WMHIs and brain infarcts.
Results—Lacunar infarcts were associated with hypertension (odds
ratio [OR], 1.79; 95% CI, 1.17 to 2.73), alcohol consumption (OR,
1.96; 95% CI, 1.17 to 3.28), and age (OR, 1.03; 95% CI, 1.00 to
1.06). Border-zone infarcts were associated with carotid
atherosclerosis (OR, 2.20; 95% CI, 1.15 to 4.19).
Atrial fibrillation (OR, 3.02; 95% CI, 1.66 to 5.50) and carotid
atherosclerosis (OR, 1.94; 95% CI, 1.12 to 3.36) were
independent positive predictors, and history of
hyperlipidemia (OR, 0.44; 95% CI, 0.26 to 0.75) and
migraine (OR, 0.48; 95% CI, 0.25 to 0.93) were negative predictors for
cortical infarcts. Patients with lacunar infarcts had more severe WMHIs
than patients with nonlacunar infarcts in all WM areas
(P
0.001). Patients with border-zone infarcts showed
severe periventricular lesions (P=0.002),
especially around posterior horns (P=0.003). The extent
of WMHIs in patients with cortical infarcts did not differ from that in
those without cortical infarcts.
Conclusions—Various infarct subtypes have different risk profiles. The association between lacunar infarcts and WMHIs supports the concept of small-vessel disease underlying these 2 phenomena. The connection between border-zone infarcts and periventricular WMHIs again raises the question of the disputed periventricular vascular border zone.
Key Words: cerebral ischemia • lacunar infarction • leukoencephalopathy • magnetic resonance imaging • white matter
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