Relation of leukoaraiosis to lesion type in stroke patients

A Hijdra, B Verbeeten, J A Verhulst
1990 Stroke  
Nonspecific periventricular white matter lucencies on computed tomograms (leukoaraiosis) were found in 141 (38%) of 367 patients with ischemic or hemorrhagic strokes. Patients with leukoaraiosis were significantly older than those without it and were significantly more likely to have hypertension, diabetes mellitus, general vascular disease, and lacunar infarcts on computed tomograms but were less likely to have cortical infarcts. Because many of these variables may be mutually dependent, we
more » ... formed a logistic regression analysis examining all clinical and computed tomographic variables. The analysis demonstrated that increasing age, lacunar infarcts, and hemorrhages were significant determinants of leukoaraiosis; cortical infarcts were also significantly, but negatively, correlated with leukoaraiosis. In patients with hemorrhages, leukoaraiosis occurred significantly more often when aneurysms or arteriovenous malformations were not demonstrated. These findings suggest that in patients with cerebrovascular disorders leukoaraiosis is associated with small-vessel disease. (Stroke 1990;21:890-894) P eriventricular white matter lucencies on computed tomograms (CT scans) in the absence of hydrocephalus or well-defined white matter diseases such as multiple sclerosis and leukodystrophies has been called leukoaraiosis. 1 This condition has been demonstrated in 1-5% of patients investigated with CT for several reasons 2 and is associated with increasing age, hypertension, and a history of cerebrovascular disease. 2 -9 Pathologic examination of the white matter shows diffuse and patchy demyelination, with hypertrophic arterioles and widened perivascular spaces. 10 - 16 The clinical and pathologic features of patients with cerebrovascular disease and leukoaraiosis suggest that the latter is associated with small-rather than large-vessel disease. Leukoaraiosis may therefore be more common in patients with the types of lesions that are mainly associated with small-vessel disease (lacunes and spontaneous intracerebral hematomas not associated with arteriovenous malformations [AVMs]) than in patients with cortical infarcts or hemorrhages from AVMs. To test this hypothesis we studied a number of clinical and CT features of 367 hospitalized patients with various types of stroke. From the Departments of Neurology (A.H., J.A.P.M.V.) and Diagnostic Radiology (B.V.),
doi:10.1161/01.str.21.6.890 pmid:2349592 fatcat:dbhjl7gdknhbzfqk3w3vpbp2qa