This Article Full Text Full Text (PDF) All Versions of this Article: 40/5/1623    most recent STROKEAHA.108.523431v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Pieters, B. Articles by Lodder, J. Search for Related Content PubMed PubMed Citation Articles by Pieters, B. Articles by Lodder, J. Related Collections Cerebral Lacunes Computerized tomography and Magnetic Resonance Imaging Pathology of Stroke

(Stroke. 2009;40:1623.)
© 2009 American Heart Association, Inc.

Original Contributions

Periventricular White Matter Lucencies Relate to Low Vitamin B12 Levels in Patients With Small Vessel Stroke

Barbe Pieters, MD; Julie Staals, MD; Iris Knottnerus, MD; Rob Rouhl, MD; Paul Menheere, MD, PhD; AlFons Kessels, MD, MSc Jan Lodder, MD, PhD

From Departments of Neurology (B.P., J.S., I.K., R.R., J.L.), Clinical Chemistry (P.M.), Clinical Epidemiology and Medical Technology Assessment (A.K.), University Hospital Maastricht, the Netherlands.

Correspondence to Dr Jan Lodder, Department of Neurology, University Hospital Maastricht, PO Box 5800, 6202 AZ, Maastricht, the Netherlands. E-mail j.lodder{at}mumc.nl

Background and Purpose— Blood–brain barrier dysfunction may be an early phenomenon in the development of the small vessel disease, which underlies white matter lesions. Because vitamin B12 plays a role in maintaining the integrity of the blood–brain barrier, we studied serum vitamin B12 level in relation to such lesions.

Methods— In 124 patients with first lacunar stroke, we measured serum vitamin B12 level and rated the degree of white matter lesions on MRI.

Results— Mean vitamin B12 level was 202 pmol/L (SD, 68.9). Thirty-nine patients (31.5%) had a vitamin B12 level less than the lower reference value of 150 pmol/L. Lower vitamin B12 level was (statistically significant) associated with more severe periventricular white matter lesions (odds ratio/100 pmol/L decrease, 1.773; 95% CI, 1.001–3.003), but not with deep white matter lesions (odds ratio/100 pmol/L decrease, 1.441; 95% CI, 0.881–2.358; ordered multivariate regression analysis).

Conclusions— More severe periventricular white matter lesions in lacunar stroke patients relate to lower vitamin B12 levels. A possible causal relationship should now be studied prospectively.

Key Words: lacunar stroke • vitamin B12 • white matter lesions