Role of hypertension in asymptomatic cerebral lacunae in the elderly.

Ikeda, Takao; Gomi, Tomoko; Kobayashi, Shiro; Tsuchiya, Hiroko

doi:10.1161/01.hyp.23.1_suppl.i259

Cited by 14 publications

(9 citation statements)

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“…Thirty of the 37 papers defined “stroke” in the index paper or related publications 8 – 16 18 – 24 26 – 30 32 – 40. Nine of the 37 papers used asymptomatic infarcts seen on brain imaging 9 10 27 29 – 31 36 – 38. The other 28 papers assessed some measure of clinical stroke of which only 9/28 papers subtyped stroke into haemorrhagic or ischaemic 8 14 15 23 26 32 – 34 40.…”

Section: Resultsmentioning

confidence: 99%

“…Two papers used specialist examination at the time of stroke;34 40 12 papers used clinical assessment but not necessarily at the time of the stroke by study investigators;11 16 17 20 23 25 32 33 35 39 43 44 14 papers used phone interviews, review of case notes or death certificates;8 12 – 15 18 19 21 22 24 26 28 41 42 and nine papers used brain imaging without clinical correlation 9 10 27 29 – 31 36 – 38…”

Section: Resultsmentioning

confidence: 99%

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Retinal microvascular abnormalities and stroke: a systematic review

Doubal

Hokke

Wardlaw

2009

Journal of Neurology, Neurosurgery & Psychiatry

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Background: Lacunar strokes account for 25% of ischaemic strokes, but their precise aetiology is unknown. Similarities between the retinal and cerebral small vessels mean that clarification of the exact relationship between retinal microvascular abnormalities and stroke, and particularly with stroke subtypes, may aid understanding of the aetiology of lacunar stroke and stroke risk. Methods: A systematic review of the literature was performed by searching Medline and Embase to October 2007 for studies in humans that investigated the association between retinal microvascular abnormalities and prevalent or incident stroke. Data and calculated summary risk ratios (sRR) were extracted for associations between retinal microvascular abnormalities and stroke, including stroke subtypes where possible, adjusted for key variables. 37 papers from 22 different studies were included with 62 975 subjects (mean age 62 years) among whom there were 2893 strokes. Stroke identification and diagnosis methods varied. Results: Retinopathy was associated with incident stroke (sRR 2.1, 95% CI 1.7 to 2.6) and prevalent stroke (sRR 2.5, 95% CI 1.4 to 4.3). Incident stroke was also associated with retinal artery embolism (sRR 2.9, 95% CI 1.6 to 5.1) and venular widening (sRR 1.4, 95% CI 1.1 to 1.7). There was significant heterogeneity between studies for some associations. There were no data on retinal microvascular abnormalities and haemorrhagic versus ischaemic stroke or ischaemic stroke subtypes. Conclusions: Retinal microvascular abnormalities are associated with stroke, but more data are required to clarify associations between specific types of retinal microvascular abnormality and stroke, as well as between different stroke subtypes. Future retinal-stroke studies should concentrate on carefully diagnosing and accurately sub-typing ischaemic stroke.Lacunar ischaemic stroke accounts for 25% of all ischaemic strokes, 1 but its precise aetiology is unknown.2 Possible causes include atherothromboembolism, 3 intracranial large artery stenosis, intrinsic microvascular atheroma, or endothelial dysfunction manifesting either through ischaemia or failure of the blood-brain barrier. 4 The cerebral blood vessels that, when diseased, give rise to lacunar stroke share many characteristics with retinal vessels, 5 being developmentally related during embryogenesis and of similar diameter (50-250 mm). Retinal vessels are visibly affected by known risk factors for stroke such as diabetes and hypertension.6 Therefore, determining any association between retinal microvascular abnormalities and stroke may improve understanding of the nature of the cerebral small vessel changes underlying lacunar ischaemic stroke and aid cerebrovascular and cardiovascular risk profiling.Several studies have examined a possible link between stroke and the retina, including large epidemiological studies in community-dwelling populations and small detailed studies of patients with specific diseases attending tertiary hospitals. The presence and strength of any repo...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Retinal microvascular abnormalities and stroke: a systematic review

Doubal

Hokke

Wardlaw

2009

Journal of Neurology, Neurosurgery & Psychiatry

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“…Recent studies have paid particular attention to hypertension: in the general population there is a striking correlation between the hypertensive state and morphological abnormalities, including cerebral atrophy and asymptomatic lacunae [23, 24]. It has been observed that the brain begins to atrophy earlier in hypertensive than in normotensive patients [25].…”

Section: Discussionmentioning

confidence: 99%

Cerebral Imaging Changes in Patients with Chronic Renal Failure Treated Conservatively or in Hemodialysis

Savazzi¹,

Cusmano

Musini³

2001

Nephron

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Background: Nonuremic patients with apparently normal memory and behavior, studied by means of cerebral computed tomography and found to have cerebral atrophy (CA), evidenced functional intellectual deficits when they underwent psychometric testing. The finding of CA has been repeatedly reported in limited case groups of uremic patients who also demonstrated functional intellectual deficits on the basis of the same tests. This retrospective study considered all diagnostic cerebral computed tomography scans done in our department between 1981 and 1998. Fifty-five uremic patients in conservative treatment (CT) and 111 patients in hemodialysis treatment (HT) were selected on the basis of the following two criteria: primary nephropathy as the cause of uremia and an age ≤55 years to exclude involutive brain changes occurring with age. Aims: The aims of the study were to determine the percent of uremic patients with CA, the characteristics of their CA (cortical or subcortical), and eventual associated morphological lesions. Results: CA was detected in 50.9% (cortical atrophy in 47.3% and subcortical atrophy in 3.6%) of the uremic patients in CT and in 77.5% of those in HT (cortical atrophy in 65.7% and subcortical atrophy in 7.7%). The average degree of CA was 0.872 in the patients in CT and 1.765 in the patients in HT. Thirty-four of the patients in the CT group and 46 in the HT group were hypertensive: these patients had a more severe degree of CA than the nonhypertensive subjects. In the CT group, the degree of CA in the hypertensive patients was 1.205 versus 0.428 for the nonhypertensive subjects. In the HT group, the degree of CA was 2.087 for the hypertensive patients versus 1.538 for the nonhypertensive patients. Of the overall population, 7.8% had ischemic lesions, 9.6% had endocranial calcifications, and 5.4% evidenced periventricular white matter hyperintensities. Conclusions: The high percent of CA found in young uremic patients increased in subjects in HT and, even more so in hypertensive patients. Vascular calcifications, focal ischemia and leukoaraiosis, well-known expressions of a chronic state of cerebrovascular insufficiency, were also found in HT patients; hypertension alone is a recognized accelerator of vascular damage. Thus, early and severe atherosclerosis and related hypoperfusion can be considered as the paramount causes of parenchymal cerebral damage in uremia.

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“…1,6,7,24 -26 A low plasma HDL-cholesterol level and a high degree of blood viscosity have also been reported as possible risk factors in studies dealing with hypertensive subjects. 25,26 Risk factors for SCI in studies on symptomatic stroke patients have been more variable. Age was the most consistent risk factor, 7-10 and other risk factors included hypertension, 5,10 male gender, 5,9,10 glucose intolerance, 4 ischemic changes on ECG, 5 and left atrial enlargement.…”

Section: Lee Et Almentioning

confidence: 99%

Prevalence and Risk Factors of Silent Cerebral Infarction in Apparently Normal Adults

et al. 2000

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Abstract-Cerebrovascular disease is a major cause of death and disability in adults. Silent cerebral infarction (SCI) portends more severe cerebral infarctions or may lead to insidious progressive brain damage resulting in vascular dementia. This study was designed to evaluate the prevalence and risk factors of SCI in an apparently normal adult population. Nine hundred ninety-four consecutive symptom-free adults (mean age 49.0Ϯ7.7; men:women 830:164) who underwent brain magnetic resonance imaging at the Center for Health Promotion at Samsung Medical Center were assessed. All were neurologically normal in history and physical examination. A total of 121 SCI lesions was observed in 58 subjects. The lesion prevalence adjusted for patient age was 5.1%. There was no gender difference in prevalence. Ninety-nine lesions were Ͻ1 cm in diameter, 15 were between 1 and 2 cm, 3 were between 2 and 3 cm, and 4 were Ͼ3 cm in diameter. The most frequent site of the SCI lesion was basal ganglia, after which the periventricular white matter, cerebral cortex, and thalamus were the most frequent sites. Old age, hypertension, a history of coronary artery disease, evidence of cardiomegaly in chest radiographs, and high fasting glucose/hemoglobin A1c levels were associated with SCI on univariate analysis. Multivariate analysis demonstrated old age and hypertension to be independent risk factors for SCI, and mild alcohol consumption was revealed as an independent protective factor against SCI. Key Words: cerebral infarction Ⅲ risk factors Ⅲ hypertension, essential Ⅲ elderly Ⅲ alcohol S ilent cerebral infarction (SCI) is defined as a brain lesion that is presumably a result of vascular occlusion found incidentally by magnetic resonance imaging (MRI) or computed tomography (CT) in otherwise healthy subjects or during autopsy. [1][2][3] It is considered a precursor of symptomatic stroke and progressive brain damage 1-3 that may be associated with vascular dementia.The reported prevalence of SCI has been varied, depending on the study subjects. In studies dealing with symptomatic stroke patients, that prevalence ranged from 10% to 38%. 4,5 A prevalence of 13% was reported in a small population study of normal subjects, 6 and in a study on a large number of elderly subjects, the prevalence was 33% in patients Ն65 years. 7 Because such variance in study subjects has led to different conclusions in regard to the prevalence and risk factors of SCI, 8 -10 we attempted to present a more comprehensive study of SCI in a relatively large population of apparently normal adults of all ages. Methods SubjectsWe studied 994 healthy consecutive subjects who visited the Center for Health Promotion at Samsung Medical Center, Seoul, Korea, from September 1994 through October 1996 and who underwent MRI of the brain as part of their routine health check. Their age ranged from 20 to 78 years; 54 subjects were Ͻ40 years, 572 subjects were between 40 and 49 years, 271 subjects were between 50 and 59 years, 81 subjects were between 60 and 69 years, and 16 subj...

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Role of hypertension in asymptomatic cerebral lacunae in the elderly.

Cited by 14 publications

References 0 publications

Retinal microvascular abnormalities and stroke: a systematic review

Retinal microvascular abnormalities and stroke: a systematic review

Cerebral Imaging Changes in Patients with Chronic Renal Failure Treated Conservatively or in Hemodialysis

Prevalence and Risk Factors of Silent Cerebral Infarction in Apparently Normal Adults

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