Periventricular white matter lucencies in patients with lacunar stroke. A marker of too high or too low blood pressure?
BACKGROUND
Periventricular white matter lucencies (PWML) have been described in stroke patients with arterial hypertension, hypotensive episodes, or increased nocturnal fall of blood pressure (BP). As a result of these mixed factors, the relationship between PWML and BP remains unsettled and the appropriate management of arterial BP in stroke patients with PWML is unknown.


OBJECTIVE
To clarify the relationship between PWML, arterial BP, and cerebral hemodynamics.


METHODS
Cohort study followed up 6 months after index stroke.


METHODS
Referral center.


METHODS
In 41 consecutive patients with first-ever lacunar infarction, the extent of PWML detected on brain magnetic resonance images was measured. Six months after stroke, BP values were monitored during a 24-hour period and transcranial Doppler examinations were performed at rest and following the administration of acetazolamide.


METHODS
Correlation of cerebral hemodynamics and BP values with the extent of PWML.


RESULTS
The severity of PWML varied substantially among patients, suggesting that PWML and lacunar infarctions could be due to several different mechanisms. Older age, elevated awake systolic BP, increased cerebrovascular tone, and the interaction between history of heart disease and the lowest heart rate were the strongest independent predictors of the severity of PWML. Diastolic BP and the vasodilatory capacity of the resistance vessels did not predict the severity of PWML.


CONCLUSIONS
Overall, PWML are markers of systolic damage in older lacunar stroke patients with stiffer arteries. In addition, hemodynamic failure may be relevant in patients with concomitant heart disease.
Chamorro
A
A
Department of Medicine, Hospital Clínic i Provincial, Barcelona, Spain.
Pujol
J
J
Saiz
A
A
Vila
N
N
Vilanova
J C
JC
Alday
M
M
Blanc
R
R
D000368:Aged; D001794:Blood Pressure; D001921:Brain / Q000473:pathology*; D002552:Cerebral Ventricles / Q000000981:diagnostic imaging / Q000473:pathology*; D002561:Cerebrovascular Disorders / Q000175:diagnosis* / Q000503:physiopathology*; D015331:Cohort Studies; D004453:Echoencephalography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D017585:Ultrasonography, Doppler, Transcranial