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Objective To investigate the relationship between cerebrovascular reserve (CVR) capacity and white matter lesions in elderly people. Methods We included 315 participants aged ≥ 60 years in Jinan area of Shandong Province from May 2018 to July 2019. They underwent transcranial Doppler ultrasonography for assessing CVR, breath holding index (BHI), and arterial pulsatility index (PI). According to CVR capacity, they were divided into normal CVR group (CVR ≥ 20%, n = 206) and impaired CVR group (CVR < 20%, n = 109). Magnetic resonance imaging was performed to evaluate periventricular, subcortical, and total white matter hyperintensity (WMH) volumes and Fazekas scores. Results Compared with the normal CVR group, the impaired CVR group showed significantly higher volumes of periventricular, subcortical, and total WMHs and significantly higher proportions of Fazekas scores ≥ 2 (P < 0.01). Periventricular, subcortical, and total WMH volumes were negatively correlated with CVR (r = −0.70, −0.66, −0.73, P < 0.01) and BHI (r = −0.64, −0.65, −0.68, P < 0.01) and positively correlated with PI (r = 0.60, 0.65, 0.65, P < 0.01). After adjusting for confounding factors, periventricular, subcortical, and total WMH volumes were still negatively correlated with CVR and BHI (P < 0.01) and positively correlated with PI (P < 0.01). The logistic regression analysis showed that the risks of periventricular, subcortical, and total Fazekas score ≥ 2 in the impaired CVR group were 1.96 times (95% confidence interval [CI]: 1.17−3.27, P < 0.01), 1.84 times (95% CI: 1.11−3.05, P < 0.05), and 2.33 times (95% CI: 1.30−4.18, P < 0.01) that of the normal CVR group, respectively. Conclusion Impaired CVR is an independent risk factor for white matter lesions in the elderly.
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Objective To investigate the relationship between cholinergic pathway damage and the executive dysfunction of patients with different degrees of cognitive impairment caused by cerebral white matter lesions(WML). Methods From March,2016 to December,2017,115 patients were recruited,whose characteristics,such as age,gender, education,and history of hypertension,diabetes and stroke were recorded.According to the T2-weighted MRI,80 patients were defined as WML.WML patients were divided into cognitively normal(CN)group(n=41),vascular cognitive impairment of none dementia(VCIND)group(n=21)and vascular dementia(VaD)group(n=18)ac-cording to the result of Montreal Cognitive Assessment(MoCA)and Clinical Dementia Rating(CDR).Other 35 cases without WML and cognitive impairment were as control group.WML under MRI were evaluated with Cho-linergic Pathways Hyperintensities Scale(CHIPS).All the WML patients were assessed with Stroop Color-Word Test,Trail Making Test, Symbol Digital Modalities Test, and Verbal Fluence Test.The correlation between the scores of CHIPS and the executive tests were analysed. Results There was no significant difference in age, gender, level of education, and cardiovascular disease risk factors among four groups(P>0.05),but there were significant differences in scores of MoCA and CHIPS(F>25.781,P<0.001),while the score of MoCA was the least(P<0.01)and the scores of CHIPS were the most in VaD group (P<0.001).The CHIPS scores of left and bilateral hemisphere negatively correlated with all the scores of execu-tive tests(P<0.05),while that of the right hemisphere just correlated with the scores of some executive tests(P<0.05). Conclusion For cognitive impairment after WML,cholinergic pathway damage may relate with the executive function impairment,especially the damage in left cerebral hemisphere.
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AIM:To observe whether selective inhibition of endothelin receptor A(ETRA)improves white matter lesions(WMLs),and explore the mechanism.METHODS:Sprague-Dawley rats(n=33)were randomly divided into sham operation group(n=9),treatment group[stroke-prone renovascular hypertensive rats-modified 2 vessel occlu-sion(RHRSP-modified 2VO)+ambrisentan(n=12)]and placebo group[RHRSP-modified 2VO +vehicle(n =12)].Drug and vehicle administration was performed from 17th to 20th week and monitoring of systolic arterial pressure was performed weekly.Morris water maze test was conducted to evaluate the function of cognition.The protein levels of en-dothelin-1(ET-1)in the cortex,corpus callosum and caudate putamen were quantitatively analyzed respectively.The se-verity of WMLs and the relationship between ET-1 and vessels were observed by the method of histopathology.RESULTS:The difference of systolic arterial pressure between treatment group and placebo group was not significant.The animals in treatment group exhibited shorter escape latency(P<0.05),more times of crossing platform(P<0.05), lower level of ET-1 in corpus callosum and caudate putamen(P<0.05),respectively,improved WMLs severity(P<0.05)and lower binding level of ET-1 to vessels compared with the placebo group.CONCLUSION: Selective inhibition of endothelin receptor A improves the severity of WMLs and ameliorates the cognitive function.
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Objective To explore the effect of patent foramen ovale(PFO)on white matter lesions(WMLs) in migraine without aura(MwoA).Methods Thirty-five patients with MwoA were examined by contrast transcranial Doppler(cTCD)and magnetic resonance imaging(MRI).According to the results of PFO and MRI Flair data,the patients' age,sex and headache characteristics were matched,and the WMLs were compared between the PFO positive group and negative group.Results Seven cases of WMLs were recruited in PFO positive group(19 cases)and the WMLs were distributed in the frontal lobe and/or the parietal lobe.The score ranged from 1 to 7 points.Five cases of WMLs were enrolled in PFO negative group(16 cases)and the WMLs also were distributed in the frontal lobe and/or the parietal lobe.The score ranged from 1 to 3 points.There was no significant difference in WMLs between the groups(P＞ 0.05).Conclusion White matter lesions in migraine without aura are distributed in the frontal lobe and the parietal lobe,and these findings do not support a relationship between PFO and WMLs.
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Objective To explore the significance of signal classification by multimodal magnetic resonance imaging(MRI)(including conventional MRI,diffusion imaging,and susceptibility-weighted imaging)on neonatal punctate white matter lesions(PWML).Methods Between March 2011 and February 2013,neonates with PWML who underwent 3.0T MRI examination were recruited.The routine protocols included T1 weighted imaging (T1WI),T2 weighted imaging(T2WI),diffusion tensor imaging(DTI),and 3D-enhanced susceptibility-weighted angiography(ESWAN).Apparent diffusion coefficient(ADC)map,magnitude image,and phase image were obtained from DTI and ESWAN,respectively.The signal of PWML was one-to-one observed on T1WI,T2WI, ADC map and magnitude image.The combined signals were classified and the number of cases of each type was counted.Results Totally 84 neonates with PWML were included(preterm/term,47/37).Seven signal types were found and classified into three groups: ① Type Ⅰ was the most,59 cases,accounting for 70.24%,with the performance of high-signal intensity on T1WI,low-signal intensity on T2WI,low-signal intensity on ADC map,and high-signal intensity on magnitude image. ② Type Ⅱ,7 cases,accounting for 8.33%,high-signal intensity on T1WI,low-signal intensity on T2WI,low-signal intensity on ADC map,and low-signal intensity on magnitude image.③ Type Ⅲ - Ⅶ,26 cases,accounting for 30.95%,high-signal intensity on T1WI,low/iso-signal intensity on T2WI,low/iso-signal intensity on ADC map,high/iso-signal intensity on magnitude image.There was no significant difference in the incidence of different signal types between preterm and full-term PWML neonates. Conclusion Magnetic resonance signal may reflect the characteristics of PWML lesions.Signal classification of PWML by multimodal magnetic resonance imaging is helpful in determining injury type and has certain significance in guiding clinical treatment.
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The number of preterm neonates appears to remain high in China in recent years.These subjects are vulnerable to pathogenic factors and have brain lesions easily.Punctate white matter lesions(PWML)are very common(the incidence＞20%).The degeneration in the brain associated with PWML is harmful to the outcomes and hard to be detected.Early diagnosis and prediction of PWML are focuses for pediatric researchers.This paper describes the change patterns and spatial distributions associated with PWML.The factors of individual differences and development during the diagnosis and prognosis are discussed as well.Finally,the paper points out the core problems in developmental brain template construction,individualized diagnosis,and early prediction.
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Objective To investigate the difference in behavioral and psychological symptoms among Al-zheimer's disease(AD)patients with different severity of white matter hyperintensity(WMH). Methods A total of 37 AD patients were enrolled and were followed-up for 4 weeks. They were checked by 3.0 T MRI at baseline, including T1,T2-weighted phase and fluid-attenuated inversion recovery sequence(FLAIR phase).The image pro-fessionals analyzed the images and process data.The Fazekas scale was used for WMH rating.Assessment tools in-cluded the Neuropsychiatric Inventory(NPI)、MMSE and ADAS-cog. Results There were 14 patients in none-mild WMH group and 23 patients in moderate-severe WMH group. The age of two groups were 71.3 ± 12.5 and 78.7 ± 6.1 years old respectively(P<0.05).The comparison of NPI,MMSE and ADAS-cog assessment results be-tween two groups show that there is significance difference in NPI baseline scoring and 4-week scoring.The score in moderate-severe group w is higher than that in the none-mild group(P < 0.05). However,the changed value of baseline-4-week NPI is not statistically significant. There is no significant difference between MMSE and ADAS -cog score and changed value.Conclusion Taken together,the severity of WMH may be related to behavioral and psychological symptoms of patients with Alzheimer's disease.
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A characteristic imaging finding in cases of methanol intoxication is putaminal necrosis, but its presence is usually not suspected due to its rarity. Methanol intoxication generally produces serious neurological symptoms that include visual disturbances and diminished consciousness, characteristically with metabolic acidosis. We reported the case of a 59-year-old man who was admitted to the hospital with diminished consciousness. Acute methanol intoxication was determined as the cause. Laboratory tests revealed high anion gap metabolic acidosis. Diffusion-weighted MRI indicated diffuse symmetric diffusion restriction lesions in the subcortical white matter of both cerebral hemispheres.
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Humanos , Persona de Mediana Edad , Equilibrio Ácido-Base , Acidosis , Encefalopatías , Cerebro , Estado de Conciencia , Difusión , Imagen por Resonancia Magnética , Metanol , Necrosis , Sustancia BlancaRESUMEN
Objective To study the risk factors of white matter lesions (WMLs), especially on the correlation of WMLs incidence with those well known risk factors for cerebrovascular disease (hypertension, hyperglycemia, hyperlipemia and smoking). Methods Four hundred and seventeen consecutive inpatients in Neurology Department of our hospital were enrolled who had undergone brain MRI. Detailed clinical history, relevant data and the Fazekas scores of WMLs were collected. Logistic regression was used to analyze the independent risk factors. Results Age (P=0.000), homocysteine level (P=0.010), grade of hypertension (P=0.007), patients with diabetes for less than 10 years (P=0.033) and smoking more than 40 years (P=0.003) were correlated with WMLs. In the group of patients with ischemic cerebrovascular disease, the independent risk factors of WMLs are Age (P=0.006), smoking (P=0.000) and grade of hypertension (P=0.028). Conclusions Age, homocysteine level and grade of hypertension are independently correlated with WMLs. Age, smoking and grade of hypertension are the independent risk factors for the patients with WMLs and ischemic cerebrovascular disease.
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Objective To investigate the potential effects of rosuvastatin on white matter lesion and spatial memo?ry function in chronic hypertensive rats. Methods Fourty-nine male Sprague-Dawley rats were randomly divided into sham-operation group, vehicle-treated group, and rosuvastatin-treated group (10 mg/kg).A model of stroke-prone reno?vascular hypertensive rat (RHRSP) was induced by using the two-kidney two clip method in the vehicle-treated group and the rosuvastatin-treated group. Blood pressure was monitored regularly. Morris water maze experiment was conduct?ed to assess spatial memory function. Luxol fast blue stanning was used to examine the degree of leukoaraiosis. Immuno?fluorescence and electron microscopy was used to detectβ-amyloid deposits. TUNEL staining was used to assess apopto?sis. Results The blood pressure of RHRSP increased progressively after operation.Blood pressure was significantly high?er in RHRSP than in sham-operation group (P<0.01). The escape latencies of the rosuvastatin-treated group were mark?edly shorter in RHRSP than in sham-operation group (P<0.01). The numbers of crossing hidden platform in the 3 groups of rats were 4.55±1.23, 1.00±0.80 and 3.79±0.95 times. There were significantly differences in numbers of crossing hid? den platform among three groups (P<0.01). Luxol fast blue stanning showed that the grading scores for WML were lower in the rosuvastatin-treated than in the vehicle-treated group (P<0.01). Rosuvastatin significantly decreased the burden of Aβdeposits(17.47±3.59 vs. 4.42±1.57,P<0.01)and the TUNEL+cells(37.84±4.73 vs. 14.42±2.43,P<0.01)in the fron?tal cortex when compared with the vehicle-treated group. Conclusions Rosuvastatin may ameliorate spatial memory func?tion through attenuation of white matter lesion, Aβdeposits and apoptosis .
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BACKGROUND: Magnetic resonance imaging (MRI) findings of white-matter lesions are different from those of lacunar infarcts; however, both these conditions are related to cardiovascular risk factors. This study was performed to investigate the differences in the relationships of white-matter lesions and lacunar infarcts with cardiovascular risk factors and differences between the metabolic characteristics of patients with these conditions. METHODS: We included 4,255 patients who showed neurological deficits during health checkups. These individuals were classified into the following 3 groups on the basis of MRI findings: normal, white-matter lesion, and lacunar infarct. The groups were compared for age; weights; prevalence of metabolic syndrome; and levels of blood pressure, blood glucose, lipid, high sensitivity C-reactive protein, and HbA1c. RESULTS: Age, body mass index (BMI); waist circumference; levels of blood pressure, blood glucose, triglycerides and HbA1c; and prevalence of metabolic syndrome and its components were the highest in lacunar infarct group, followed by white matter lesion group, and normal group. Age and diastolic blood pressure level were related to white matter lesions, and age, systolic blood pressure level, and blood glucose level were related to lacunar infarcts. Further, the prevalence of the above-mentioned lesions increased with increase of the number of the components of metabolic syndrome. CONCLUSIONS: This study suggests that lacunar infarct is more advanced lesion than white matter lesion. Among all the cardiovascular risk factors, high blood pressure and impaired fasting blood glucose levels were significantly related to white-matter lesions and lacunar infarct.
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Humanos , Glucemia , Presión Sanguínea , Índice de Masa Corporal , Proteína C-Reactiva , Ayuno , Hipertensión , Imagen por Resonancia Magnética , Prevalencia , Factores de Riesgo , Accidente Vascular Cerebral Lacunar , TriglicéridosRESUMEN
BACKGROUND: Endothelial dysfunction is suggested to be one of the pathogenesis of cerebral white matter lesion (cWML). Vascular endothelial growth factor (VEGF) plays a crucial role in angiogenesis and integrity of vascular endothelial cell, and altered expression of VEGF gene induces vascular diseases including cerebrovascular diseases. The objective of this study is to investigate whether single nucleotide polymorphism (SNP) of VEGF gene confers an increased risk of cWML. METHODS: Total 337 study subjects without history of stroke were included. The presence and severity of cWML were measured on fluid-attenuated inversion recovery image. Genotypes of VEGF -2578G>A, -1154G>A, -634G>C and +936C>T were analyzed. RESULTS: Among 337 study subjects, cWML was found in 208 patients (62%), and fifty-eight cases (17%) of them had overt cWML. In univariate analysis, age, female sex and plasma total homocysteine level (tHcyt) were higher in the mild and overt cWML group than no cWML group (p<0.05). The percentage of previous history of hypertension and the value of systolic blood pressure were higher in overt cWML group than no cWML group. In univariate and logistic regression analysis, none of four tested VEGF SNPs was significantly different between control group, mild and overt cWML groups. There was no difference between plasma tHcyt levels and each VEGF SNPs in control group and cWML groups. CONCLUSIONS: In this study, old age, female sex, hypertension and plasma tHcyt were associated with cWML. However, we failed to find an association between cWML and VEGF gene polymorphism, which may indicate that genetic polymorphism of VEGF does not play a direct role in the pathogenesis of cWML.
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Femenino , Humanos , Presión Sanguínea , Células Endoteliales , Genotipo , Homocisteína , Hipertensión , Modelos Logísticos , Plasma , Polimorfismo Genético , Polimorfismo de Nucleótido Simple , Accidente Cerebrovascular , Enfermedades Vasculares , Factor A de Crecimiento Endotelial VascularRESUMEN
BACKGROUND: An alpha2-adrenergic receptor (alpha2-AR, ADRA2) mediates induction of hypotension and inhibition of lipolysis and insulin secretion. We evaluated whether single nucleotide polymorphisms (SNPs) of alpha2A (ADRA2A), alpha2B (ADRA2B), and alpha2C (ADRA2C) adrenergic receptors are associated with cerebral white matter lesion (cWML). METHODS: Total 336 study subjects who had no stroke were enrolled in this study. The Indices of cWML include total WML (TWML), periventricular WML (PVWML), and subcortical WML (SCWML) on brain fluid-attenuated inversion recovery (FLAIR) image. Common genetic variants of ADRA2A (1780G>A), ADRA2B (Ins/Del301-303), and ADRA2C (Ins/Del322-325) were examined. RESULTS: Among 336 study subjects, cWML was found in 66 patients (20%). In multivariate analysis, there were no significant effects of all tested ADRA2 polymorphisms on TWML. Significant association of ADRA2A 1780 AA genotype was found in PVWML (OR: 3.368, 95% CIs: 1.280-8.865, adjusted p-value after false discovery rate (FDR) correction=0.014) but not SCWML. CONCLUSION: Although SNPs of three ADRA2 subtypes failed to reach a significance in overall risk for cWML, the ADRA2A 1780G>A polymorphism may be associated with development of PVWML.
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Humanos , Encéfalo , Genotipo , Hipotensión , Insulina , Lipólisis , Análisis Multivariante , Polimorfismo de Nucleótido Simple , Receptores Adrenérgicos , Accidente CerebrovascularRESUMEN
Head MRI and CT scans Can frequently find ischemic cerebral white matter lesions in healthy elderly and in patients with atherosclerosis.Ischemic cerebral white matter lesions are regarded as a manifestation of cerebral small vessel lesions.which Can result in symptoms such as cognitive impairment,and predict extraeranial or intracranial ischemic events.This article reviews the recent progress in research on cerebral white matter lesions.their pathogenesis and clirilcal significance.
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BACKGROUND: Hyperhomocysteinemia increase the risk of vascular disease, dementia and cognitive impairment. The effect of homocysteine on cognitive function may be as a consequence of direct neurotoxicity or indirectly through cerebrovascular disease. Thus we examined the association between homocysteine levels and cognitive function, and assess whether this may be mediated by cerebral white matter lesions. METHODS: Non-dementic participants were recruited from March to December 2005, and underwent brain MRI. White matter hyperintensities(WMH) were rated visually by 4-class WMH grades. Informations of age, gender, education and vascular risk factor were obtained from interview. Cognitive function were assessed by using K-MMSE and HDS-R. The cross-sectional relationship between homocysteine level and cognitive test score was assessed by multiple regression analysis. RESULTS: Severe WMH groups more exposed to vascular risk factor such as age, hypertension and higher levels of homocyteine. More severe WMH grades also had lower K-MMSE and HDS-R score. Higher group of homocysteine concentration were significantly related to poorer performances on K-MMSE and HDS-R tests. In multiple linear regression analyses for the relationship between homocysteine and cognitive performances, higher homocysteine level was also related to lower cognitive performances. Adding cerebral WMH changes to the level of homocysteine did not significantly change the effect of homocysteine on cognitive ability, and cerebral WMH had a separate and additive effect with homocysteine. CONCLUSIONS: Elevated homocysteine level is associated decreased cognitive score and cerebral white matter lesion on MRI is independent association to the cognitive abilities.
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Encéfalo , Demencia , Educación , Homocisteína , Hiperhomocisteinemia , Hipertensión , Modelos Lineales , Imagen por Resonancia Magnética , Factores de Riesgo , Enfermedades VascularesRESUMEN
Objective: Executive dysfunction is a typical characteristic of vascular cognitive impairment(VCI),with subcortical ischemia as its pathological basis.The aim of this study was to investigate the characteristics of event-related potential of visual-spatial working memory based on ischemic white matter lesions,and offer more electrophysiological evidence for the evaluation of VCI.Methods: We included in this study 24 patients with ischemic white matter lesions(13 mild and 11 severe cases) and 12 elderly healthy controls,and induced event-related potentials(ERP) of visual-spatial working memory from the delayed matching-to-sample task in all the participants.Results: Three waves were identified: N330,P420 and late negative component. On the two-ball-load,the N330 amplitude in the middle frontal,right frontal and occipital lobe was significantly smaller in the mild and severe lesion groups(P