12 Mar 21. Featured Paper

Lacunar stroke lesion extent & location & white matter hyperintensities evolution 1 year post-lacunar stroke.

Link to paper on Frontiers in Neurology

Authors

Maria del C. Valdés Hernández, Tara Grimsley-Moore, Eleni Sakka, Michael J. Thrippleton, Francesca M. Chappell, Paul A. Armitage, Stephen Makin & Joanna M. Wardlaw

Abstract

Lacunar strokes are a common type of ischemic stroke.

They are associated with long-term disability, but the factors affecting the dynamic of the infarcted lesion & the brain imaging features associated with them, reflective of small vessel disease (SVD) severity, are still largely unknown.

We investigated whether the distribution, volume & 1-year evolution of white matter hyperintensities (WMH), one of these SVD features, relate to the extent & location of these infarcts, accounting for vascular risk factors.

We used imaging & clinical data from all patients [n = 118, mean age 64.9 (SD 11.75) years old] who presented to a regional hospital with a lacunar stroke syndrome within the years 2010 & 2013 & consented to participate in a study of stroke mechanisms.

All patients had a brain MRI scan at presentation, & 88 had another scan 12 months after.

Acute lesions (i.e., recent small subcortical infarcts, RSSI) were identified in 79 patients & lacunes in 77.

Number of lacunes was associated with baseline WMH volume (B = 0.370, SE = 0.0939, P = 0.000174).

RSSI volume was not associated with baseline WMH volume (B = 3.250, SE = 2.117, P = 0.129), but predicted WMH volume change (B = 2.944, SE = 0.913, P = 0.00184).

RSSI location was associated with the spatial distribution of WMH & the pattern of 1-year WMH evolution.

Patients with the RSSI in the centrum semiovale (n = 33) had significantly higher baseline volumes of WMH, recent & old infarcts, than patients with the RSSI located elsewhere [median 33.69, IQR (14.37 50.87) ml, 0.001 ≤ P ≤ 0.044].

But patients with the RSSI in the internal/external capsule/lentiform nucleus experienced higher increase of WMH volume after a year [n = 21, median (IQR) from 18 (11.70 31.54) ml to 27.41 (15.84 40.45) ml].

Voxel-wise analyses of WMH distribution in patients grouped per RSSI location revealed group differences increased in the presence of vascular risk factors, especially hypertension & recent or current smoking habit.

In our sample of patients presenting to the clinic with lacunar strokes, lacunar strokes extent influenced WMH volume fate; & RSSI location & WMH spatial distribution & dynamics were intertwined, with differential patterns emerging in the presence of vascular risk factors.

These results, if confirmed in wider samples, open potential avenues in stroke rehabilitation to be explored further.

Keywords

• Lacunar
• Lacunes of presumed vascular origin
• Recent small subcortical infarct
• Stroke
• Vascular risk factors
• White matter hyperintensities