Risk factors of white matter hyperintensities in South Asian patients with transient ischemic attack and minor stroke
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DIAGNOSTIC NEURORADIOLOGY
Risk factors of white matter hyperintensities in South Asian patients with transient ischemic attack and minor stroke Nikhil Hiremath 1 & Mahesh Kate 2 & Aneesh Mohimen 3 & Chandrasekharan Kesavadas 3 & P. N. Sylaja 1 Received: 19 January 2020 / Accepted: 2 April 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Aging and increased burden of cardiovascular risk factors are associated with severity of white matter hyperintensity (WMH). We assessed the burden and risk factor profile of WMHs in South Asian patients with transient ischemic attack (TIA) and minor stroke. Methods Patients with acute ischemic stroke with the National Institute of Health stroke scale (NIHSS) score ≤ 5 who underwent MRI were included. The severity of WMHs was assessed based on age-related white matter change (ARWMC) scale (0–30). A score of > 8 or more was considered moderate-severe involvement. Logistic regression analysis was performed to assess the association with risk factors. Results A total of 424 patients with a mean ± SD age of 57.4 ± 14.5 years [females, 108 (25.5%)] were analyzed. Fifty-four (12.7%) patients had moderate or severe WMHs (ARWMC score > 8). Age (OR 1.03, 95% CI 1.01–1.06; p = 0.004), hypertension (OR 2.3, 95% CI 1.1–5.1; p = 0.03) and smoking tobacco (OR 2.8, 95% CI 1.4–5.6; p = 0.003) were independently associated with ARWMC score > 8. The median (IQR) regional score in patients with ARWMC score > 8 was maximum in frontal areas 4 (4–6, p < 0.0001) and parietooccipital areas 4.5(4–6, p < 0.0001). The presence of microbleeds (OR 6.3, 95% CI 3.1–12.7; p < 0.0001) was independently associated with ARWMC score > 8. Conclusion South Asian patients with TIA and minor stroke are relatively young, and few patients have moderate and severe WMHs. Hypertension and tobacco smoking increases the risk of WMH. Targeting modifiable risk factors may reduce the burden of WMHs and vascular dementia. Keywords White matter hyperintensities . Magnetic resonance imaging . Risk factor . Acute stroke . Transient ischemic attack . Small vessel disease
Introduction Cerebral white matter hyperintensities of presumed vascular origin (WMHs) of varying severity is one of the most common age-related changes seen on magnetic resonance imaging NH and MK contributed equally to this work. * P. N. Sylaja [email protected] 1
Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala 695011, India
2
Department of Clinical Neurosciences, Alberta Health Services, Edmonton, Canada
3
Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
(MRI). [1] The observed mechanism of WMHs is vasculopathy of the small perforating arterioles and is preceded by dynamic dysfunction of endothelium, cerebral autoregulation, and blood-brain barrier (BBB) [2]. WMHs are highly prevalent (28.4–72.5%)
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