The association between b-WMHs and stroke remained significant after adjustment for age, sex, and supratentorial WMHs (s‑WMHs), but lost statistical significance when additional vascular risk factors were included.
Abstract
Background: No prior research has determined whether brainstem white matter hyperintensities (b-WMHs) are associated with first-ever stroke. This study aims to investigate whether b-WMHs can predict first-ever stroke.
Methods: This was a retrospective study. Clinical records and magnetic resonance imaging (MRI) scans reviewed to identify patients with and without brainstem white matter hyperintensities (b-WMHs). A total of 180 individuals with b-WMHs and no prior history of stroke, and 205 individuals without b-WMHs, were included. Stroke incidence within a three‑year observation window was determined retrospectively from medical records and confirmed by neuroimaging, following American Heart Association/American Stroke Association (AHA/ASA) guidelines. Predictors of stroke were evaluated using Cox regression analysis.
Results: Within the three‑year observation window, 37 patients (9.6%) experienced a first‑ever stroke, 40.5% in the anterior circulation and 59.5% in the posterior circulation. Stroke incidence was significantly higher among patients with b‑WMHs (13%) compared with those without (6%) (OR, 2.27; 95% CI, 1.12–4.61; P=0.02). In multivariable Cox regression analysis, stroke occurrence was independently associated with hypertension (HR, 5.39; P<0.001), diabetes mellitus (HR, 4.39; P=0.007), hyperhomocysteinemia (HR, 2.66; P=0.004), and atrial fibrillation (HR, 3.00; P<0.01). The association between b‑WMHs and stroke remained significant after adjustment for age, sex, and supratentorial WMHs (s‑WMHs), but lost statistical significance when additional vascular risk factors were included.
Conclusion: Brainstem white matter hyperintensities are associated with first-ever stroke but are not independent risk factors. Further studies are needed to explore the mechanisms linking b-WMHs to stroke risk.
INTRODUCTION
White matter hyperintensities (WMH) are key radiographic biomarkers of cerebral small vessel disease (CSVD) and have been associated with worse outcomes after stroke. Since CSVD may involve blood-brain barrier disruption, we hypothesized that worse outcomes in those with WMH may be mediated through more severe cerebral edema and hemorrhagic transformation (HT).
METHODS
In this retrospective multicenter cohort study, we studied patients from four multinational stroke cohorts who presented within 12 h of anterior circulation large vessel occlusion (LVO) stroke and received at least one follow-up computed tomography (CT) between 12 and 48 h. WMH were rated on baseline CTs using a Fazekas-derived system, with a subset also assessed with Fazekas grading on magnetic resonance imaging (MRI). Automated image analysis measured cerebrospinal fluid displacement (ΔCSF) and lesional-to-contralateral hemispheric CSF volumes (CSF-ratio) as quantitative edema biomarkers. We analyzed the association between WMH presence and edema severity, hemorrhagic transformation, and poor functional outcome (mRS 3-6), adjusting for key covariates, overall and in the subgroup undergoing thrombectomy and those with successful reperfusion.
RESULTS
Of 1290 patients with LVO, 782 were eligible for analysis. Of these, 19% had WMH on CT. Patients with WMH were older, more often female, and had a history of hypertension and higher presenting systolic blood pressure and glucose levels. WMH presence was associated with worse functional outcome, adjusting for age and additional covariates [OR 1.84 (1.06-3.22), p = 0.04] but lower risk of any HT [OR 0.48 (0.25-0.88), p = 0.03]. However, WMH presence by CT or MRI was not associated with edema (ΔCSF, CSF ratio, or midline shift) in the whole population or thrombectomy/reperfusion subgroups. Reperfusion was associated with less edema and improved recovery.
CONCLUSIONS
Presence of CT-graded WMH was associated with worse outcome after LVO stroke, independent of age and other factors. However, this risk appears not to be mediated through greater risk of HT or cerebral edema formation.
Patients with WMH exhibit alterations in EEG microstate features that are significantly correlated with WMH burden and cognitive function, and classification models based on these microstate features show promise for practical application in WMH-related dementia.
Kai-Yan Feng, Jia-Xin Cai, Jian-Ming Lei et al.· Frontiers in Neuroscience· 0 citations
WMH are common in adults with focal epilepsy, and the frontal lobe is the most frequently affected region, and age, seizure duration, interictal epileptiform discharges, and seizure duration are independent risk factors for greater WMH burden.
Xu Zhang, Wenjie Zhang, Chang Ge et al.· Clinical EEG and Neuroscienc...· 0 citations
WMHs are common MRI findings in patients with migraine, particularly in older patients and those with chronic or long-standing disease, and may improve the interpretation of MRI findings and contribute to a better understanding of migraine-related brain changes.
Aqeela, K. Nawaz, Sania Saeed et al.· International journal of pat...· 0 citations
Diffusion MRI biomarkers were abnormal at least a decade before WMH abnormality in the population, revealing a prolonged phase of early SVD and highlighting their potential for SVD prevention.
P. Vemuri, Ming-Zhao Hu, Emily S. Lundt et al.· Stroke· 0 citations
Objective: White matter hyperintensities (WMH) are among the most common imaging markers of cerebral small vessel disease and may reflect diffuse cerebrovascular vulnerability. This study aimed to investigate the relationship between WMH burden and intracranial aneurysm (IA) rupture.
Materials and Methods: This retrospective observational study included 120 patients with digital subtraction angiography (DSA)-confirmed intracranial aneurysms. Patients were categorized into ruptured (n = 72) and unruptured (n = 48) aneurysm groups. Demographic characteristics, vascular risk factors, aneurysm morphology, and WMH burden were evaluated. WMH severity was assessed using the Fazekas scale on T2-weighted and fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) sequences. Multivariate logistic regression analysis was performed to identify factors independently associated with aneurysm rupture.
Results: Hypertension, smoking, anterior communicating artery aneurysms location, higher aspect ratio, and bleb or secondary outpouching were more frequent in ruptured aneurysms. Total WMH score was significantly higher in the ruptured group (median 3 [0–6] vs. 2 [0–5], P = .005). Multivariable analysis demonstrated that AComA location (OR: 2.61, 95% CI: 1.17–5.82, P = .018), presence of bleb or secondary outpouching (OR: 3.38, 95% CI: 1.54–7.40, P = .002), and total WMH score (OR: 1.28, 95% CI: 1.05–1.56, P = .014) were independently associated with aneurysm rupture. No significant association was found between WMH burden and modified Fisher score among patients with ruptured aneurysms.
Conclusions: Increased WMH burden was independently associated with IA rupture. These findings suggest that aneurysm rupture may be influenced not only by local aneurysm morphology but also by diffuse cerebrovascular vulnerability. WMH burden may represent a potential imaging marker associated with aneurysm instability and rupture risk.
