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Cerebrovascular Diseases (Basel,... 2009This article reviews published stroke subtype classification systems and offers rules and a basis for a new way to subtype stroke patients. Stroke subtyping can have... (Review)
Review
This article reviews published stroke subtype classification systems and offers rules and a basis for a new way to subtype stroke patients. Stroke subtyping can have different purposes, e.g. describing patients' characteristics in a clinical trial, grouping patients in an epidemiological study, careful phenotyping of patients in a genetic study, and classifying patients for therapeutic decision-making in daily practice. The classification should distinguish between ischemic and hemorrhagic stroke, subarachnoid hemorrhage, cerebral venous thrombosis, and spinal cord stroke. Regarding the 4 main categories of etiologies of ischemic stroke (i.e. atherothrombotic, small vessel disease, cardioembolic, and other causes), the classification should reflect the most likely etiology without neglecting the vascular conditions that are also found (e.g. evidence of small vessel disease in the presence of severe large vessel obstructions). Phenotypes of large cohorts can also be characterized by surrogate markers or intermediate phenotypes (e.g. presence of internal carotid artery plaque, intima-media thickness of the common carotid artery, leukoaraiosis, microbleeds, or multiple lacunae). Parallel classifications (i.e. surrogate markers) may serve as within-study abnormalities to support research findings.
Topics: Diagnosis, Differential; Humans; Phenotype; Stroke
PubMed: 19342825
DOI: 10.1159/000210432 -
European Stroke Journal Jun 2021'Covert' cerebral small vessel disease (ccSVD) is common on neuroimaging in persons without overt neurological manifestations, and increases the risk of future stroke,...
'Covert' cerebral small vessel disease (ccSVD) is common on neuroimaging in persons without overt neurological manifestations, and increases the risk of future stroke, cognitive impairment, dependency, and death. These European Stroke Organisation (ESO) guidelines provide evidence-based recommendations to assist with clinical decisions about management of ccSVD, specifically white matter hyperintensities and lacunes, to prevent adverse clinical outcomes. The guidelines were developed according to ESO standard operating procedures and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. We prioritised the clinical outcomes of stroke, cognitive decline or dementia, dependency, death, mobility and mood disorders, and interventions of blood pressure lowering, antiplatelet drugs, lipid lowering, lifestyle modifications, glucose lowering and conventional treatments for dementia. We systematically reviewed the literature, assessed the evidence, formulated evidence-based recommendations where feasible, and expert consensus statements. We found little direct evidence, mostly of low quality. We recommend patients with ccSVD and hypertension to have their blood pressure well controlled; lower blood pressure targets may reduce ccSVD progression. We do not recommend antiplatelet drugs such as aspirin in ccSVD. We found little evidence on lipid lowering in ccSVD. Smoking cessation is a health priority. We recommend regular exercise which may benefit cognition, and a healthy diet, good sleep habits, avoiding obesity and stress for general health reasons. In ccSVD, we found no evidence for glucose control in the absence of diabetes or for conventional Alzheimer dementia treatments. Randomised controlled trials with clinical endpoints are a priority for ccSVD.
PubMed: 34414301
DOI: 10.1177/23969873211012132 -
Frontiers in Human Neuroscience 2022Leukoaraiosis is a common imaging marker of cerebral small vessel disease. In recent years, with the continuous advances in brain imaging technology, the detection rate... (Review)
Review
Leukoaraiosis is a common imaging marker of cerebral small vessel disease. In recent years, with the continuous advances in brain imaging technology, the detection rate of leukoaraiosis is higher and its clinical subtypes are gradually gaining attention. Although leukoaraiosis has long been considered an incidental finding with no therapeutic necessity, there is now growing evidence linking it to, among other things, cognitive impairment and a high risk of death after stroke. Due to different research methods, some of the findings are inconsistent and even contradictory. Therefore, a comprehensive and in-depth study of risk factors for leukoaraiosis is of great clinical significance. In this review, we summarize the literature on leukoaraiosis in recent years with the aim of elucidating the disease in terms of various aspects (including pathogenesis, imaging features, and clinical features, etc.).
PubMed: 36061509
DOI: 10.3389/fnhum.2022.902731 -
Stroke Oct 2010Leukoaraiosis is a common finding in stroke patients and has been strongly associated with risk of incident stroke and dementia. Leukoaraiosis may also be an independent... (Review)
Review
Leukoaraiosis is a common finding in stroke patients and has been strongly associated with risk of incident stroke and dementia. Leukoaraiosis may also be an independent predictor of stroke outcomes. There is increasing evidence from neuroimaging to support the concept that some leukoaraiosis is caused by white matter infarcts, which may be particularly frequent in patients with aggressive small vessel diseases such as cerebral amyloid angiopathy. The relatively similar distribution of leukoaraiosis regardless of the distribution of vascular pathology suggests a conserved vulnerability to white matter injury across various vascular diseases, possibly related to resting patterns of blood flow. More insights into the pathophysiology of leukoaraiosis are sorely needed to reduce the burden of disability associated with this common condition.
Topics: Brain; Humans; Leukoaraiosis; Risk Factors; Stroke
PubMed: 20876490
DOI: 10.1161/STROKEAHA.110.596056 -
Chonnam Medical Journal Aug 2011Cerebrovascular disease is the second leading cause of cognitive impairment in the elderly, either alone or in combination with Alzheimer's disease (AD). Vascular...
Cerebrovascular disease is the second leading cause of cognitive impairment in the elderly, either alone or in combination with Alzheimer's disease (AD). Vascular dementia (VaD) is heterogeneous in terms of both clinical phenotype and pathogenetic mechanisms. It may result from multiple cortical infarctions due to cerebral large vessel pathologies or to subcortical ischemic changes such as leukoaraiosis or lacunar infarction due to cerebral small artery disease. Clinical symptoms and signs vary depending on the location and size of the stroke lesion, and no single neuropsychological profile characteristic of VaD has been defined, although dysexecutive function is common. A slightly higher mortality rate and slower progression are reported in VaD compared with AD. VaD is potentially preventable by rigorous identification and treatment of cardiovascular disease risk factors, and modest symptomatic improvement with cholinesterase inhibitors has been reported.
PubMed: 22111063
DOI: 10.4068/cmj.2011.47.2.66 -
Polish Journal of Radiology 2018Leukoaraiosis is a pathological appearance of the brain white matter, which has long been believed to be caused by perfusion disturbances within the arterioles... (Review)
Review
Leukoaraiosis is a pathological appearance of the brain white matter, which has long been believed to be caused by perfusion disturbances within the arterioles perforating through the deep brain structures. Due to its complex etiopathogenesis and clinical relevance, leukoaroisosis has been investigated in a multitude of studies. As regards the clinical implications of leukoaraiosis, this neuroimaging finding is strongly related to ischaemic stroke, unfavourable course of ischaemic stroke in the acute phase, worse long-term outcomes, and cognitive disturbances. The morphological changes in the deep white matter that are collectively described as leukoaraiosis, despite a seemingly homogenous appearance, probably resulting from various causes, such as atherosclerosis, neurotoxic factors including radiation therapy and chemotherapy, and neuroinfections. Based on our experience and recent literature, we present the symptomatology of leukoaroisosis and similar radiological abnormalities of the cerebral white matter.
PubMed: 30038682
DOI: 10.5114/pjr.2018.74344 -
Frontiers in Neuroscience 2021Leukoaraiosis, also called white matter hyperintensities (WMH), is frequently encountered in the brain of older adults. During aging, gray matter structure is also...
Leukoaraiosis, also called white matter hyperintensities (WMH), is frequently encountered in the brain of older adults. During aging, gray matter structure is also highly affected. WMH or gray matter defects are commonly associated with a higher prevalence of mild cognitive impairment. However, little is known about the relationship between WMH and gray matter. Our aim was thus to explore the relationship between leukoaraiosis severity and gray matter volume in a cohort of healthy older adults. Leukoaraiosis was rated in participants from the PROOF cohort using the Fazekas scale. Voxel-based morphometry was performed on brain scans to examine the potential link between WMH and changes of local brain volume. A neuropsychological evaluation including attentional, executive, and memory tests was also performed to explore cognition. Out of 315 75-year-old subjects, 228 had punctuate foci of leukoaraiosis and 62 had begun the confluence of foci. Leukoaraiosis was associated with a decrease of gray matter in the middle temporal gyrus, in the right medial frontal gyrus, and in the left parahippocampal gyrus. It was also associated with decreased performances in memory recall, executive functioning, and depression. In a population of healthy older adults, leukoaraiosis was associated with gray matter defects and reduced cognitive performance. Controlling vascular risk factors and detecting early cerebrovascular disease may prevent, at least in part, dementia onset and progression.
PubMed: 35095388
DOI: 10.3389/fnins.2021.747569 -
Frontiers in Neurology 2022Microvascular failure might result in the collapse of cerebral collaterals. However, controversy remains regarding the role of leukoaraiosis (LA) in collateral...
BACKGROUND AND OBJECTIVE
Microvascular failure might result in the collapse of cerebral collaterals. However, controversy remains regarding the role of leukoaraiosis (LA) in collateral recruitment. We, therefore, performed a systematic review and meta-analysis of the association between LA and cerebral collaterals.
METHODS
Ovid Medline, PubMed, Embase, Web of Science, and three Chinese databases were searched from inception to August 2021. Two types of cerebral collaterals, including Circle of Willis (CoW) and leptomeningeal collaterals (LC), were investigated separately. Random effect models were used to calculate the pooled odds ratio (OR). Meta-regression and subgroup analyses were performed to explore the potential sources of heterogeneity.
RESULTS
From 14 studies ( = 2,451) that fulfilled our inclusion criteria, data from 13 could be pooled for analysis. Overall, there was a significant association between severe LA and incomplete CoW (pooled OR 1.66, 95% CI 1.18-2.32, = 0.003), with low heterogeneity ( = 5.9%). This association remained significant in deep LA (pooled OR 1.48, 95% CI 1.04-2.11, = 0.029, = 0), but not periventricular LA. Similarly, there was a significant association between LA and LC (pooled OR 1.73, 95% CI 1.03-2.90, = 0.037), but with high heterogeneity ( = 67.2%). Meta-regression indicated a negative association of sample size with the effect sizes ( = 0.029). In addition, most of the studies (7/9) included into the analysis of the relationship of severe LA with poor LC enrolled subjects with large vessel occlusion stroke, and this relationship remained significant when pooling the seven studies, but with high heterogeneity.
CONCLUSION
Severe LA is associated with a higher prevalence of poor collaterals. This association is robust for CoW but weak for LC. Further studies are required to explore the underlying mechanisms.
PubMed: 35812112
DOI: 10.3389/fneur.2022.869329 -
Neurology India 2022Leukoaraiosis is thought to be related to long-standing microvascular ischemia. The pathogenic mechanisms and hemodynamic changes could be different for periventricular...
BACKGROUND AND PURPOSE
Leukoaraiosis is thought to be related to long-standing microvascular ischemia. The pathogenic mechanisms and hemodynamic changes could be different for periventricular and deep white matter leukoaraiosis. In this cross-sectional study, we examined whether the Pulsatility Index (PI) in Transcranial Doppler ultrasonography (TCD), which can give indirect information regarding downstream microvascular resistance and compliance, is different for leukoaraiosis in periventricular and deep locations. Correlation between presence of leukoaraiosis and PI was also studied since it was not studied in South-Asian patients before.
METHODS
Consecutive patients with suspected lacunar stroke or white-matter disease, undergoing MR brain imaging were included. Vascular imaging was done with CT or MR Angiography to rule out significant (>50%) stenosis. Fazeka's grading was done for severity of leukoaraiosis and mean PI in the middle cerebral artery (MCA) was obtained with trans-temporal TCD.
RESULTS
Ninety patients (Mean age 61 ± 10.9 years, 29% females) were available for final analysis. Age, hypertension, diabetes mellitus, CAD, and presence of leukoaraiosis were strongly associated with elevated mean PI in univariate analysis. In multivariate analysis, presence of leukoaraiosis was significantly associated with higher mean PI after adjusting for other variables. Mean PI strongly correlated with both periventricular (Spearman's correlation coefficient 0.56, P = 0.01) and deep white matter (Spearman's correlation coefficient 0.63, P = 0.01) leukoaraiosis.
CONCLUSIONS
Our study confirms the correlation of Pulsatility Index with leukoaraiosis in South-Asian patients. Interestingly, changes in microvascular resistance appeared to be similar for both periventricular and deep white matter leukoaraiosis in spite of potential differences in etiopathogenesis.
Topics: Aged; Asia; Cross-Sectional Studies; Female; Humans; Leukoaraiosis; Male; Middle Aged; Middle Cerebral Artery; Ultrasonography, Doppler, Transcranial
PubMed: 35532642
DOI: 10.4103/0028-3886.344637 -
PloS One 2018The impact of leukoaraiosis on the risk of symptomatic intracerebral hemorrhage (SICH) after stroke thrombolysis is conflicting, and the data on Asian populations are...
BACKGROUND
The impact of leukoaraiosis on the risk of symptomatic intracerebral hemorrhage (SICH) after stroke thrombolysis is conflicting, and the data on Asian populations are lacking. Therefore, in this study, we assessed the association between leukoaraiosis and SICH, and the association between leukoaraiosis and the 90-day functional outcome in the Asian population.
METHODS
Data were collected from a two-center prospective registry of acute ischemic stroke patients given intravenous tissue plasminogen activator between 2006 and 2014. A total of 614 pretreatment brain CT and 455 posttreatment MRI were retrospectively assessed using two different rating scales for the presence of leukoaraiosis. Outcome measures were the occurrence of SICH with three definitions and any hemorrhage after thrombolysis and functional outcome at 3 months.
RESULTS
Of the 614 patients assessed, 30.3% showed severe leukoaraiosis on the baseline brain CT. The SICH rate was 4.6% - 7.2% based on different definitions, and overall, 24.9% of patients showed any post-tPA hemorrhage. No association was observed between the severity of leukoaraiosis and SICH, regardless of having used different leukoaraiosis rating scales or as assessment using different imaging modalities. However, severe leukoaraiosis was independently associated with poor functional outcome at 3 months (OR 1.96, 95% C1 1.24-3.11, P = 0.004) after adjustment for confounders.
CONCLUSIONS
Our results showed no association between leukoaraiosis and the risk of SICH. Although the presence of severe leukoaraiosis predicted a poor functional outcome after stroke, IV thrombolysis might not be withheld in acute ischemic stroke patients solely based on the presence of severe leukoaraiosis on pre-thrombolytic CT scans.
Topics: Aged; Female; Humans; Intracranial Hemorrhages; Leukoaraiosis; Male; Middle Aged; Risk Factors; Stroke; Thrombolytic Therapy; Tissue Plasminogen Activator; Treatment Outcome
PubMed: 29715283
DOI: 10.1371/journal.pone.0196505