title: Differential risk factors for lacunar stroke depending on the MRI (white and red) subtypes of microangiopathy.
abstract: BACKGROUND
  Leukoaraiosis and cerebral microbleeds (CMB), which represent cerebral microangiopathy, commonly coexist in patients with acute lacunar stroke. Since they may have different impacts on stroke prognosis and treatment, it is important to know the factors associated with leukoaraiosis-predominant vs. CMB-predominant microangiopathies.
  
  
  METHODS
  We prospectively recruited 226 patients with acute lacunar infarction and divided them into four groups according to the Fazekas' score and the presence of CMB: mild, red (predominant CMB), white (predominant leukoaraiosis) and severe microangiopathy groups. For comparison, we also evaluated 50 patients with intracerebral hemorrhage (ICH). We evaluated the clinical and laboratory findings of microangiopathy subtypes in patients with acute lacunar stroke and then compared them with those of primary ICH.
  
  
  RESULTS
  The risk factor profile was different among the groups. Patients with acute lacunar infarct but mild microangiopathy were younger, predominantly male, less hypertensive, and more frequently had smoking and heavy alcohol habits than other groups. The risk factor profile of red microangiopathy was similar to that of ICH but differed from that of white microangiopathy. The subjects in the white microangiopathy group were older and more frequently had diabetes than those in the red microangiopathy or ICH group. After adjustments for other factors, age [odds ratio (OR) 1.13; 95% confidence interval (CI) 1.08-1.18; p<0.001] and diabetes (OR 2.28; 95% CI 1.02-5.13; p = 0.045) were independently associated with white microangiopathy, and age (OR 1.05; 95% CI 1.01-1.08; p = 0.010) was independent predictor for red microangiopathy compared to mild microangiopathy.
  
  
  CONCLUSIONS
  Patients with acute lacunar infarction have a different risk factor profile depending on microangiopathic findings. Our results indicate that diabetes may be an one of determinants of white (leukoaraiosis-predominant) microangiopathy, whereas smoking and alcohol habits in relatively young people may be a determinants of mild microangiopahic changes in patients with lacunar infarction.
authors.affiliation: Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jae-Hyun
authors.initials: JH
authors.lastname: Park
authors.forename: Sookyung
authors.initials: S
authors.lastname: Ryoo
authors.forename: Suk Jae
authors.initials: SJ
authors.lastname: Kim
authors.forename: Gyeong-Moon
authors.initials: GM
authors.lastname: Kim
authors.forename: Chin-Sang
authors.initials: CS
authors.lastname: Chung
authors.forename: Kwang Ho
authors.initials: KH
authors.lastname: Lee
authors.forename: Oh Young
authors.initials: OY
authors.lastname: Bang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D049292:Leukoaraiosis / Q000150:complications* / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D059409:Stroke, Lacunar / Q000150:complications* / Q000175:diagnosis*