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Neurology. 2017 Sep 5;89(10):1003-1010. doi: 10.1212/WNL.0000000000004328. Epub 2017 Aug 9.

White matter hyperintensity reduction and outcomes after minor stroke.

Author information

1
From the Centre for Clinical Brain Sciences (J.M.W., F.M.C., M.d.C.V.H., K.S., M.J.T., S.M.-M., A.K.H., E.S., M.S.D.), UK Dementia Research Institute at the University of Edinburgh (J.M.W.), Centre for Cognitive Aging and Cognitive Epidemiology (J.M.W., M.d.C.V.H., S.M.-M.), University of Edinburgh; Institute of Cardiovascular and Medical Sciences (S.D.J.M.), University of Glasgow, UK; Department of Neurology and Cardiovascular Research Institute Maastricht (J.S.), Maastricht University Medical Centre, the Netherlands; and Academic Unit of Radiology (P.A.A.), Department of Cardiovascular Science, University of Sheffield, UK. joanna.wardlaw@ed.ac.uk.
2
From the Centre for Clinical Brain Sciences (J.M.W., F.M.C., M.d.C.V.H., K.S., M.J.T., S.M.-M., A.K.H., E.S., M.S.D.), UK Dementia Research Institute at the University of Edinburgh (J.M.W.), Centre for Cognitive Aging and Cognitive Epidemiology (J.M.W., M.d.C.V.H., S.M.-M.), University of Edinburgh; Institute of Cardiovascular and Medical Sciences (S.D.J.M.), University of Glasgow, UK; Department of Neurology and Cardiovascular Research Institute Maastricht (J.S.), Maastricht University Medical Centre, the Netherlands; and Academic Unit of Radiology (P.A.A.), Department of Cardiovascular Science, University of Sheffield, UK.

Abstract

OBJECTIVE:

To assess factors associated with white matter hyperintensity (WMH) change in a large cohort after observing obvious WMH shrinkage 1 year after minor stroke in several participants in a longitudinal study.

METHODS:

We recruited participants with minor ischemic stroke and performed clinical assessments and brain MRI. At 1 year, we assessed recurrent cerebrovascular events and dependency and repeated the MRI. We assessed change in WMH volume from baseline to 1 year (normalized to percent intracranial volume [ICV]) and associations with baseline variables, clinical outcomes, and imaging parameters using multivariable analysis of covariance, model of changes, and multinomial logistic regression.

RESULTS:

Among 190 participants (mean age 65.3 years, range 34.3-96.9 years, 112 [59%] male), WMH decreased in 71 participants by 1 year. At baseline, participants whose WMH decreased had similar WMH volumes but higher blood pressure (p = 0.0064) compared with participants whose WMH increased. At 1 year, participants with WMH decrease (expressed as percent ICV) had larger reductions in blood pressure (β = 0.0053, 95% confidence interval [CI] 0.00099-0.0097 fewer WMH per 1-mm Hg decrease, p = 0.017) and in mean diffusivity in normal-appearing white matter (β = 0.075, 95% CI 0.0025-0.15 fewer WMH per 1-unit mean diffusivity decrease, p = 0.043) than participants with WMH increase; those with WMH increase experienced more recurrent cerebrovascular events (32%, vs 16% with WMH decrease, β = 0.27, 95% CI 0.047-0.50 more WMH per event, p = 0.018).

CONCLUSIONS:

Some WMH may regress after minor stroke, with potentially better clinical and brain tissue outcomes. The role of risk factor control requires verification. Interstitial fluid alterations may account for some WMH reversibility, offering potential intervention targets.

PMID:
28794252
PMCID:
PMC5589793
DOI:
10.1212/WNL.0000000000004328
[Indexed for MEDLINE]
Free PMC Article

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