White matter hyperintensity volume is increased in small vessel stroke subtypes.
OBJECTIVE
White matter hyperintensity (WMH) may be a marker of an underlying cerebral microangiopathy. Therefore, we hypothesized that WMH would be most severe in patients with lacunar stroke and intracerebral hemorrhage (ICH), 2 types of stroke in which cerebral small vessel (SV) changes are pathophysiologically relevant.


METHODS
We determined WMH volume (WMHV) in cohorts of prospectively ascertained patients with acute ischemic stroke (AIS) (Massachusetts General Hospital [MGH], n = 628, and the Ischemic Stroke Genetics Study [ISGS], n = 263) and ICH (MGH, n = 122).


RESULTS
Median WMHV was 7.5 cm³ (interquartile range 3.4-14.7 cm³) in the MGH AIS cohort (mean age 65 ± 15 years). MGH patients with larger WMHV were more likely to have lacunar stroke compared with cardioembolic (odds ratio [OR] = 1.87 per SD normally transformed WMHV), large artery (OR = 2.25), undetermined (OR = 1.87), or other (OR = 1.85) stroke subtypes (p < 0.03). These associations were replicated in the ISGS cohort (p = 0.03). In a separate analysis, greater WMHV was seen in ICH compared with lacunar stroke (OR = 1.2, p < 0.02) and in ICH compared with all ischemic stroke subtypes combined (OR = 1.34, p < 0.007).


CONCLUSIONS
Greater WMH burden was associated with SV stroke compared with other ischemic stroke subtypes and, even more strongly, with ICH. These data, from 2 independent samples, support the model that increasing WMHV is a marker of more severe cerebral SV disease and provide further evidence for links between the biology of WMH and SV stroke.
J. Philip Kistler Stroke Research Center, Center for Human Genetics Research, Massachusetts General Hospital, 175 Cambridge St, Suite 300, Boston, MA 02114, USA. nrost@partners.org
N S
NS
Rost
R M
RM
Rahman
A
A
Biffi
E E
EE
Smith
A
A
Kanakis
K
K
Fitzpatrick
F
F
Lima
B B
BB
Worrall
J F
JF
Meschia
R D
RD
Brown
T G
TG
Brott
A G
AG
Sorensen
S M
SM
Greenberg
K L
KL
Furie
J
J
Rosand
D000368:Aged; D000369:Aged, 80 and over; D020520:Brain Infarction / Q000150:complications / Q000473:pathology; D002545:Brain Ischemia / Q000150:complications / Q000473:pathology*; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000150:complications / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D055806:Microvessels / Q000473:pathology*; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D011446:Prospective Studies; D020521:Stroke / Q000150:complications / Q000473:pathology*