White matter hyperintensity burden and susceptibility to cerebral ischemia.
OBJECTIVE
White matter hyperintensity (WMH) burden increases risk of ischemic stroke; furthermore, it predicts infarct growth in acute cerebral ischemia. We hypothesized that WMH would be less severe in patients with TIA as compared to those with acute ischemic stroke and completed infarct.


METHODS
Cases (TIA, n = 30) and controls (acute ischemic stroke, n = 120) were selected from an ongoing longitudinal cohort study of patients with stroke and matched for age, gender, and race/ethnicity. All subjects had brain MRI within 48 hours of presentation to evaluate for evidence of acute cerebral ischemia. WMH burden on MRI was quantified using a validated computer-assisted program with high inter-rater reliability.


RESULTS
Median WMH volume in individuals with TIA was 3.7 cm³ (interquartile range, 1.5 - 8.33 cm³) compared to 6.9 cm³ (interquartile range, 3.1-11.9 cm³) in acute ischemic stroke (P < 0.04). In multivariable analysis, the odds of completed infarct were higher (OR, 2.19; 95% CI, 1.27-3.77; P < 0.005) in subjects with larger volumes of WMH.


CONCLUSIONS
WMH burden was significantly less in subjects with TIA as opposed to those with ischemic stroke. These data provide further evidence to support a detrimental role of WMH burden on the capacity of cerebral tissue to survive acute ischemia.
Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA. nrost@partners.org
Natalia S
NS
Rost
Kaitlin
K
Fitzpatrick
Alessandro
A
Biffi
Allison
A
Kanakis
William
W
Devan
Christopher D
CD
Anderson
Lynelle
L
Cortellini
Karen L
KL
Furie
Jonathan
J
Rosand
D000367:Age Factors; D000368:Aged; D001921:Brain / Q000473:pathology*; D002545:Brain Ischemia / Q000453:epidemiology* / Q000473:pathology*; D016022:Case-Control Studies; D002544:Cerebral Infarction / Q000453:epidemiology / Q000473:pathology; D015331:Cohort Studies; D005006:Ethnicity; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006949:Hyperlipidemias / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D007091:Image Processing, Computer-Assisted; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000473:pathology; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology / Q000473:pathology
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors