Emerging role of white matter lesions in cerebrovascular disease

Abstract

White matter lesions have been implicated in the setting of stroke, dementia, intracerebral haemorrhage, several other cerebrovascular conditions, migraine, various neuroimmunological diseases like multiple sclerosis, disorders of metabolism, mitochondrial diseases and others. While much is understood vis a vis neuroimmunological conditions, our knowledge of the pathophysiology of these lesions, and their role in, and implications to, management of cerebrovascular diseases or stroke, especially in the elderly, are limited. Several clinical assessment tools are available for delineating white matter lesions in clinical practice. However, their incorporation into clinical decision‐making and specifically prognosis and management of patients is suboptimal for use in standards of care. This article sought to provide an overview of the current knowledge and recent advances on pathophysiology, as well as clinical and radiological assessment, of white matter lesions with a focus on its development, progression and clinical implications in cerebrovascular diseases. Key indications for clinical practice and recommendations on future areas of research are also discussed. Finally, a conceptual proposal on putative mechanisms underlying pathogenesis of white matter lesions in cerebrovascular disease has been presented. Understanding of pathophysiology of white matter lesions and how they mediate outcomes is important to develop therapeutic strategies.

Stroke Aetiology and Collateral Status in Acute Ischemic Stroke Patients Receiving Reperfusion Therapy—A Meta-Analysis

“…A higher neutrophil count one day after hospital admission was associated with sICH while a higher NLR was associated with parenchymal haemorrhage and sICH [ 33 ]. We postulate that the progression to poor outcomes despite good collateral status and successful reperfusion, e.g., in AIS patients with LAA, may be explained by other factors such as NLR [ 42 ] and severity of leukoaraiosis [ 44 , 45 ].…”

Impact of diabetes on clinical and safety outcomes in acute ischemic stroke patients receiving reperfusion therapy: A meta-analysis

“…40 Factors such as delayed onset-to-reperfusion time and leukoaraiosis have also been implicated. 3,41 Regardless, studies have shown that reperfusion therapy is safe for patients with diabetes and leads to better outcomes compared to patients who did not receive reperfusion therapy. 30,42 During the current coronavirus disease 2019 (CO-VID-19) pandemic, an increasing attention is being paid to the disproportionate burden on patients with pre-existing diabetes.…”

“…1 The advent of reperfusion treatment, intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) offers the opportunity to significantly improve the outcomes after acute ischemic stroke (AIS). 2 Moreover, since 2015, in the era of EVT, an increasing attention has been paid to identifying patients or stratifying them based on the clinical profiles or imaging factors, 3,4 who are more likely to benefit from time-critical therapies. [5][6][7][8][9] As such, it is of clinical relevance to fully delineate the role of diabetes in AIS, in the setting of reperfusion therapy.…”

Prognostic Role of Chronic Rhinosinusitis in Acute Ischemic Stroke Patients Undergoing Mechanical Thrombectomy

“…The relevant literature reports multiple examples of clinical, biological, biochemical, and radiological factors with potential relevance to the prognosis for ischaemic stroke patients treated with mechanical thrombectomy [22,23]. The factors associated with a poorer prognosis following thrombectomy include: age, comorbitidies (HA, DM), previous stroke, stroke severity, the Alberta Stroke Program Early CT Score (ASPECTS), ischemic core volume, mismatch of ischemic core and hypoperfusion volume, white matter lesions, the location of the occlusion, collateral flow status and neutrophil lymphocyte ratio [5][6][7][8]24,25].…”