White matter hyperintensity reduction and outcomes after minor stroke

Wardlaw, J. M. et al. (2017) White matter hyperintensity reduction and outcomes after minor stroke. Neurology, 89(10), pp. 1003-1010. (doi: 10.1212/WNL.0000000000004328) (PMID:28794252) (PMCID:PMC5589793)

Abstract

Objective: To assess factors associated with white matter hyperintensity (WMH) change in a large cohort after observing obvious WMH shrinkage 1 year after minor stroke in several participants in a longitudinal study. Methods: We recruited participants with minor ischemic stroke and performed clinical assessments and brain MRI. At 1 year, we assessed recurrent cerebrovascular events and dependency and repeated the MRI. We assessed change in WMH volume from baseline to 1 year (normalized to percent intracranial volume [ICV]) and associations with baseline variables, clinical outcomes, and imaging parameters using multivariable analysis of covariance, model of changes, and multinomial logistic regression. Results: Among 190 participants (mean age 65.3 years, range 34.3–96.9 years, 112 [59%] male), WMH decreased in 71 participants by 1 year. At baseline, participants whose WMH decreased had similar WMH volumes but higher blood pressure (p = 0.0064) compared with participants whose WMH increased. At 1 year, participants with WMH decrease (expressed as percent ICV) had larger reductions in blood pressure (β = 0.0053, 95% confidence interval [CI] 0.00099–0.0097 fewer WMH per 1–mm Hg decrease, p = 0.017) and in mean diffusivity in normal-appearing white matter (β = 0.075, 95% CI 0.0025–0.15 fewer WMH per 1-unit mean diffusivity decrease, p = 0.043) than participants with WMH increase; those with WMH increase experienced more recurrent cerebrovascular events (32%, vs 16% with WMH decrease, β = 0.27, 95% CI 0.047–0.50 more WMH per event, p = 0.018). Conclusions: Some WMH may regress after minor stroke, with potentially better clinical and brain tissue outcomes. The role of risk factor control requires verification. Interstitial fluid alterations may account for some WMH reversibility, offering potential intervention targets.

• Item Type: Articles
• Additional Information: The project was funded by the Wellcome Trust (WT088134/Z/09/A; S.D.J.M, project costs), the Row Fogo Charitable Trust (M.d.C.V.H., A.K.H.), AgeUK (S.M.-M.), the European Union Horizon 2020 project 666881, SVDs@Target (F.M.C.). The Brain Imaging Centre is supported by the Scottish Funding Council SINAPSE Initiative (www. sinapse.ac.uk); funding from the Fondation Leducq (16-CVD-05) is gratefully acknowledged. J.S. was supported by Maastricht University Medical Centre Academic Fund.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Makin, Dr Stephen
• Authors: Wardlaw, J. M., Chappell, F. M., Valdés Hernández, M. D. C., Makin, S. D.J., Staals, J., Shuler, K., Thrippleton, M. J., Armitage, P. A., Muñoz-Maniega, S., Heye, A. K., Sakka, E., and Dennis, M. S.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Neurology
• Publisher: Lippincott, Williams and Wilkins
• ISSN: 0028-3878
• ISSN (Online): 1526-632X
• Published Online: 09 August 2017
• Copyright Holders: Copyright © 2017 The Authors
• First Published: First published in Neurology 89(10): 1003-1010
• Publisher Policy: Reproduced under a Creative Commons license