Leukoaraiosis and cause of death: a five year follow up.

Tarvonen-Schröder, Sinikka; Kurki, Timo; Räihä, Ismo; Sourander, L.

doi:10.1136/jnnp.58.5.586

Cited by 21 publications

(15 citation statements)

References 24 publications

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“…Our findings support the opinion that the white-matter involvement is a disease manifestation of the vascular system and not a manifestation of the aging process per se. This is in agreement with other clinical studies that have found WMCs to be related to heart failure, atrial fibrillation [26, 27]and hypertension [28, 29]. As both hypotension [30]and low nocturnal BP [31]have also been found to be related to WMCs, the relationship between BP and WMCs appears to be complex.…”

Section: Discussionsupporting

confidence: 79%

Symptoms, Vascular Risk Factors and Blood-Brain Barrier Function in Relation to CT White-Matter Changes in Dementia

et al. 2000

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The aim was to study the frequently found white-matter changes on computerized tomography (CT) in patients with dementia and to relate these changes to clinical regional brain symptomatology, vascular factors, albumin ratio [indicator of blood-brain barrier (BBB) function] and other CT changes. The study included 85 patients, average age 71 ± 8, with Alzheimer’s disease (n = 56) and vascular dementia (n = 29), who underwent CT (Siemens Somatome DR 1) of the brain. They were inpatients in a psychiatric department specialized in dementia investigations. The degree of CT white-matter changes (absence, mild-moderate, severe) was the basis for the division of the patients into three groups. As the patients without white-matter changes were significantly younger than those with such changes, all statistical analyses were controlled for age. Subcortical symptomatology was significantly more frequent in the group with severe white-matter changes, whereas the reverse was true for parietal symptomatology. Diabetes mellitus, hypertension, ischemic cardiac disease and lacunas were significantly more common in patients with white-matter changes, whereas the freqeuncy of transient ischemic attack/stroke episodes did not differ significantly between the groups. The albumin ratio was significantly higher in the groups with white-matter changes and highest in the group with severe white-matter changes. The findings indicate that white-matter changes in demented patients are at least partially an age- and stroke-independent disease manifestation of the vascular system and is associated with a specific symptom pattern. BBB dysfunction may be the link between the vasculature and the tissue damage.

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Section: Discussionsupporting

confidence: 79%

Symptoms, Vascular Risk Factors and Blood-Brain Barrier Function in Relation to CT White-Matter Changes in Dementia

et al. 2000

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“…Independent of surgery, surgically treated patients who had widespread LA had a greater chance of dying from vascular death (10.1%, 6.8%, 3.6%; Pϭ0.02, log-rank test, for comparison of the 3 subgroups). Three prospective hospital-based studies [31][32][33] had already focused on survival and causes of death among elderly patients with LA. In all 3 studies, LA predicted death (particularly vascular death in 1 study) 32 independently of other death predictors in aged patients.…”

Section: La As a Predictor Of Ischemic Stroke Or Vascular Deathmentioning

confidence: 99%

Leukoaraiosis

Inzitari

2003

Stroke

119

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Background-Leukoaraiosis, a term that defines an abnormal appearance of the subcortical white matter of the brain on neuroimaging (bilateral patchy or diffuse areas of low attenuation on CT or hyperintense T2 MR areas), has gained evidence in retrospective studies to demonstrate its association with stroke and in prospective studies to demonstrate its prognostic value related to the occurrence of stroke, both ischemic and hemorrhagic, or the occurrence of vascular death. Summary of Review-The subtype of ischemic stroke most strongly predicted by leukoaraiosis is lacunar infarct, which is likely caused by the same underlying small-vessel pathology. Leukoaraiosis has been shown to predispose to intracerebral hemorrhage at both the basal-ganglionic and lobar sites, primarily when leukoaraiosis is extensive and patients are treated with anticoagulants because of prior ischemic events. Conclusions-Leukoaraiosis shares with stroke common pathophysiological mechanisms and, because it is likely an expression of the same disease, must be regarded as an intermediate surrogate of stroke rather than a true stroke risk factor. Key Words: leukoaraiosis Ⅲ risk factors Ⅲ stroke I n 1987, Hachinski and coworkers 1 used the term leukoaraiosis (LA) (from the Greek: leukoϭwhite; araiosisϭrarefaction) to describe an abnormal CT appearance of the subcortical brain white matter, seen as bilateral patchy or diffuse areas of reduced x-ray attenuation with ill-defined margins, limited to the periventricular regions or extended to the centrum semiovale ( Figure 1). On T2 or fluid-attenuated inversion recovery (FLAIR) MRI sequences, LA appears as hyperintense periventricular caps or rims or halos or subcortical multiple punctuate or patchy, partially confluent or confluent areas. The degree of these changes is variable. Examples of MRI-disclosed LA of increasing severity are shown in Figure 2. On the basis of multiple findings, including some recent observations using MRI perfusion, 2 these changes are likely ischemic in nature and are caused by hypoperfusion in the distal deep arterial or arteriolar territories. 3 Lipohyalinosis (arteriolosclerosis), produced by chronic hypertension with or without diabetes, also related to lacunar infarction (LI) and intracerebral hemorrhage (ICH), is thought to be the hallmark pathological process altering small vessels. Pontine hyperintense lesions, usually combined with hemispheric LA, have been reported as a LA subtype, possibly produced through the same mechanisms. 4 LA may also be caused by cerebral amyloid angiopathy (CAA) or cerebral autosomal dominant arteriopathy stroke and ischemic leukoencephalopathy (CADASIL). 3 Evidence is being accumulated to document that the presence of LA is associated with a history of stroke and also predicts the future occurrence of either ischemic or hemorrhagic stroke. The aim of this article is to review the evidence on the risk of stroke among patients presenting with LA and to discuss whether LA should be considered more properly a stroke risk factor or an inter...

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“…TarvonenSchroder et al studied the clinical features of leukoaraiosis and found that the frequency of heart failure and systolic hypotension -but not hypertension-was higher in the leukoaraiosis positive group than in the controls (27). Another study showed that LA is more likely to be associated with a cardiovascular cause of death suggesting a relationship between LA and cardiac disorders (28). In our study, an association between cardiac insufficiency and leukoaraiosis was not found although subjects with cardiac insufficiency were at a risk of having white matter lesions.…”

Section: Discussionmentioning

confidence: 99%