on March 12, 2009
Published online before print March 12, 2009, doi: 10.1161/STROKEAHA.108.523431
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Submitted on April 17, 2008
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. * To whom correspondence should be addressed. 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.
Revised on November 25, 2008
Accepted on December 1, 2008
Periventricular White Matter Lucencies Relate to Low Vitamin B12 Levels in Patients With Small Vessel Stroke
Barbe Pieters MD;
Key words: lacunar stroke • vitamin B12 • white matter lesions