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(Stroke. 2008;39:3083.)
© 2008 American Heart Association, Inc.

Research Letters

On the Etiology of Incident Brain Lacunes

Longitudinal Observations From the LADIS Study

Alida A. Gouw, MD; Wiesje M. van der Flier, PhD; Leonardo Pantoni, MD, PhD; Domenico Inzitari, MD; Timo Erkinjuntti, MD, PhD; Lars O. Wahlund, MD, PhD; Gunhild Waldemar, MD, DMSc; Reinhold Schmidt, MD; Franz Fazekas, MD; Philip Scheltens, MD, PhD; Frederik Barkhof, MD, PhD on behalf of the LADIS Study Group

From the Alzheimer Center (A.A.G., W.M.v.d.F., P.S., F.B.) and the Department of Neurology (A.A.G., W.M.v.d.F., P.S.), the Department of Radiology (F.B.), Image Analysis Center (A.A.G., F.B.), Vrije Universiteit Medical Center, Amsterdam, The Netherlands; the Department of Neurological and Psychiatric Sciences (L.P., D.I.), University of Florence, Italy; Memory Research Unit, Department of Clinical Neurosciences (T.E.), Helsinki University, Finland; the Karolinska Institutet, Department of Neurobiology (L.O.W.), Care Sciences and Society, Karolinska University Hospital Huddinge, Sweden; the Memory Disorders Research Unit, Department of Neurology (G.W.), Copenhagen University Hospital, Denmark; and the Department of Neurology and MRI Institute (R.S., F.F.), Medical University, Graz, Austria.

Correspondence to A.A. Gouw, Department of Neurology, Alzheimer Center and Image Analysis Center, Vrije Universiteit Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands. E-mail AA.Gouw{at}vumc.nl

Background and Purpose— We investigated regional differences in MRI characteristics and risk factor profiles of incident lacunes over a 3-year period.

Methods— Baseline and 3-year follow-up MRI were collected within the LADIS study (n=358). Incident lacunes were characterized with respect to brain region, their appearance within pre-existent white matter hyperintensities (WMH), surrounding WMH size, and risk factors.

Results— 106 incident lacunes were observed in 62 patients (58 subcortical white matter [WM], 35 basal ganglia, and 13 infratentorial). Incident subcortical WM lacunes occurred more often within preexisting WMH (P=0.01) and were mostly accompanied by new and expanded WMH (P<0.001), compared to incident basal ganglia and infratentorial lacunes. Risk factors for incident subcortical WM lacunes were history of hypertension and stroke, whereas atrial fibrillation predicted incident basal ganglia/infratentorial lacunes.

Conclusion— Differences in relation to WMH and risk factor profiles may suggest that incident lacunes in the subcortical WM have a different pathogenesis than those in the basal ganglia and infratentorial region.

Key Words: lacunes • white matter hyperintensities • MRI

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