Association between white matter hyperintensities and stroke in a West African patient population: Evidence from the Stroke Investigative Research and Educational Network study

Li, Jingfei; Ogbole, Godwin; Aribisala, Benjamin S.; Affini, Murtala; Yaria, Joseph; Kehinde, Issa; Rahman, Mukaila Alade; Fakunle, Adekunle; Banjo, Rasaq; Faniyan, Moyinoluwalogo; Akinyemi, Rufus; Ovbiagele, Bruce; Sammet, Steffen

doi:10.1016/j.neuroimage.2020.116789

Cited by 7 publications

(5 citation statements)

References 45 publications

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“…37 The LST has been used to estimate WMH using clinical FLAIR scans of various resolutions. 38 Lesions are segmented in new images by providing an estimate for the lesion probability for each voxel (Figure 1). WMH were quantified using total lesion volume (TLV) calculated using the LPA.…”

Section: Neuropathologic Evaluationmentioning

confidence: 99%

Association Between Antemortem FLAIR White Matter Hyperintensities and Neuropathology in Brain Donors Exposed to Repetitive Head Impacts

et al. 2022

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Background and Objectives:Late neuropathologies of repetitive head impacts from contact sports can include chronic traumatic encephalopathy (CTE) and white matter degeneration. White matter hyperintensities (WMH) on fluid attenuated inversion recovery (FLAIR) MRI scans are often viewed as microvascular disease from vascular risk, but might have unique underlying pathologies and risk factors in the setting of repetitive head impacts. We investigated the neuropathological correlates of antemortem WMH in brain donors exposed to repetitive head impacts. The association between WMH, and repetitive head impact exposure and informant-reported cognitive and daily function were tested.Methods:This imaging-pathological correlation study included symptomatic deceased men exposed to repetitive head impacts. Donors had antemortem FLAIR scans from medical records and were without evidence of CNS neoplasm, large vessel infarcts, hemorrhage, and/or encephalomalacia. WMH were quantified using log-transformed values for total lesion volume (TLV), calculated using the lesion prediction algorithm from the Lesion Segmentation Toolbox. Neuropathological assessments included semi-quantitative ratings of white matter rarefaction, cerebrovascular disease, p-tau severity (CTE stage, dorsolateral frontal cortex), and Aβ. Among football players, years of play was a proxy for repetitive head impact exposure. Retrospective informant-reported cognitive and daily function were assessed using the Cognitive Difficulties Scale (CDS) and Functional Activities Questionnaire (FAQ). Regression models controlled for demographics, diabetes, hypertension, and MRI resolution. Statistical significance was defined as p<0.05.Results:The sample included 75 donors: 67 football players and 8 non-football contact sport athletes and/or military veterans. Dementia was the most common MRI indication (64%). Fifty-three (70.7%) had CTE at autopsy. Log-TLV was associated with white matter rarefaction (OR=2.32, 95% CI=1.03,5.24, p=0.04), arteriolosclerosis (OR=2.38, 95% CI=1.02,5.52, p=0.04), CTE stage (OR=2.58, 95% CI=1.17,5.71, p=0.02), and dorsolateral frontal p-tau severity (OR=3.03, 95% CI=1.32,6.97, p=0.01). There was no association with Aβ. More years of football play was associated with log-TLV (b=0.04, 95% CI=0.01,0.06, p=0.01). Greater log-TLV correlated with higher FAQ (unstandardized beta=4.94, 95% CI=0.42,8.57, p=0.03) and CDS scores (unstandardized beta=15.35, 95% CI=-0.27,30.97, p=0.05).Discussion:WMH might capture long-term white matter pathologies from repetitive head impacts, including those from white matter rarefaction and p-tau, in addition to microvascular disease. Prospective imaging-pathological correlation studies are needed.Classification of Evidence:This study provides Class IV evidence of associations between FLAIR white matter hyperintensities, and neuropathological changes (white matter rarefaction, arteriolosclerosis, p-tau accumulation), years of American football play, and reported cognitive symptoms in symptomatic brain donors exposed to repetitive head impacts.

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Section: Neuropathologic Evaluationmentioning

confidence: 99%

Association Between Antemortem FLAIR White Matter Hyperintensities and Neuropathology in Brain Donors Exposed to Repetitive Head Impacts

et al. 2022

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“…6–8. 17–58 An additional 14 studies were excluded from the meta-analyses as they were repeated publications from the same cohort (n = 8); without complete data for meta-analysis (n = 4); and with unclear results reporting (n = 2). For multiple publications from the same cohort, we selected a representative study from each cohort based on the following: a greater number of cSVD markers reported, preference for more recent publications, and larger sample size.…”

Section: Resultsmentioning

confidence: 99%

The global burden of cerebral small vessel disease in low- and middle-income countries: A systematic review and meta-analysis

Lam

Yuan

Akinyemi

et al. 2022

International Journal of Stroke

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Background Cerebral small vessel disease (cSVD) is a major cause of stroke and dementia. Previous studies on the prevalence of cSVD are mostly based on single geographically-defined cohorts in high-income countries. Studies investigating the prevalence of cSVD in low- and middle-income countries (LMICs) are expanding but have not been systematically assessed. Aim This study aims to systematically review the prevalence of cSVD in LMICs. Results Articles were searched from the Ovid MEDLINE and EMBASE databases from 1st Jan 2000 to 31st March 2022, without language restrictions. Title/abstract screening, full-text review, and data extraction were performed by 2-7 independent reviewers. The prevalence of cSVD and study sample size were extracted by pre-defined world regions and health status. The Risk of Bias for Non-randomized Studies tool was used. The protocol was registered on PROSPERO (CRD42022311133). A meta-analysis of proportion was performed to assess the prevalence of different MRI markers of cSVD and a meta-regression was performed to investigate associations between cSVD prevalence and type of study, age, and male: female ratio. Of 2,743 studies identified, 42 spanning 12 global regions were included in the systematic review. Most of the identified studies were from China (n=23). The median prevalence of moderate-to-severe white matter hyperintensities (WMH) was 20.5%, 40.5%, and 58.4% in the community, stroke, and dementia groups, respectively. The median prevalence of lacunes was 0.8% and 33.52% in the community and stroke groups. The mean prevalence of cerebral microbleeds (CMB) was 10.7% and 22.4% in the community and stroke groups. The mean prevalence of moderate-to-severe perivascular spaces was 25.0% in the community. Meta-regression analyses showed that the weighted median age (51.4 ± 0.0 years old; range: 36.3-80.2) was a significant predictor of the prevalence of moderate-to-severe WMH and lacunes, while the type of study was a significant predictor of the prevalence of CMB. The heterogeneity of studies was high (> 95%). Male participants were overrepresented. Conclusions This systematic review and meta-analysis provide data on cSVD prevalence in LMICs and demonstrated the high prevalence of the condition. cSVD research in LMICs is being published at an increasing rate, especially between 2010-2022. More data is particularly needed from Sub-Saharan Africa & Central Europe, Eastern Europe & Central Asia.

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“…With regard to poor late neurological outcome they suggested that patients with preexisting brain damage have less ability to compensate functionally than those without preexisting damage. Moreover, Li and colleagues [ 59 ] studied 130 West African patients and revealed that age, waist-to-hip ratio and platelet count were positively linearly related to WMH volume, whereas high WMH volume showed a strong association with poor early (1 month) stroke functional outcome. With respect to platelet count the authors propose that by playing a key role in the inflammatory pathway in the endothelium, platelets may be implicated in small vessel disease, as measured by WMH volumes.…”

Section: Discussionmentioning

confidence: 99%

The Clinical Utility of Leukoaraiosis as a Prognostic Indicator in Ischemic Stroke Patients

Christidi

Tsiptsios

Sousanidou

et al. 2022

Neurology International

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Stroke constitutes a major cause of functional disability with increasing prevalence among adult individuals. Thus, it is of great importance for both clinicians and stroke survivors to be provided with a timely and accurate prognostication of functional outcome. A great number of biomarkers capable of yielding useful information regarding stroke patients’ recovery propensity have been evaluated so far with leukoaraiosis being among them. Literature research of two databases (MEDLINE and Scopus) was conducted to identify all relevant studies published between 1 January 2012 and 25 June 2022 that dealt with the clinical utility of a current leukoaraiosis as a prognostic indicator following stroke. Only full-text articles published in English language were included. Forty-nine articles have been traced and are included in the present review. Our findings highlight the prognostic value of leukoaraiosis in an acute stroke setting. The assessment of leukoaraiosis with visual rating scales in CT/MRI imaging appears to be able to reliably provide important insight into the recovery potential of stroke survivors, thus significantly enhancing stroke management. Yielding additional information regarding both short- and long-term functional outcome, motor recovery capacity, hemorrhagic transformation, as well as early neurological deterioration following stroke, leukoaraiosis may serve as a valuable prognostic marker poststroke. Thus, leukoaraiosis represents a powerful prognostic tool, the clinical implementation of which is expected to significantly facilitate the individualized management of stroke patients.

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Association between white matter hyperintensities and stroke in a West African patient population: Evidence from the Stroke Investigative Research and Educational Network study

Cited by 7 publications

References 45 publications

Association Between Antemortem FLAIR White Matter Hyperintensities and Neuropathology in Brain Donors Exposed to Repetitive Head Impacts

Association Between Antemortem FLAIR White Matter Hyperintensities and Neuropathology in Brain Donors Exposed to Repetitive Head Impacts

The global burden of cerebral small vessel disease in low- and middle-income countries: A systematic review and meta-analysis

The Clinical Utility of Leukoaraiosis as a Prognostic Indicator in Ischemic Stroke Patients

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