Advertisement

Frequency of white matter lesions and silent lacunar infarcts

  • E. J. van Dijk
  • N. D. Prins
  • S. E. Vermeer
  • P. J. Koudstaaf
  • M. M. B. Breteler
Part of the Journal of Neural Transmission. Supplementa book series (NEURAL SUPPL, volume 62)

Abstract

White matter lesions and silent lacunar infarcts are related to andmay result from cerebral small vessel disease. Reported frequencies of theselesions vary largely among studies. Differences in imaging techniques, ratingscales, cut-off points in lesion severity grading and study populations contribute to the variation, in addition to differences in risk factor profiles acrossstudies.

In this paper, we will firstly discuss general methodological issues that may influence reported frequencies of white matter lesions and silent lacunar infarctions, and then review published data. We will focus on the results from population-based studies and only briefly comment on patient series fo stroke and dementia.

Keywords

Vascular Dementia White Matter Lesion Lacunar Infarct Cardiovascular Health Study Lewy Body Dementia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Barber R, Scheltens P, Gholkar A, Ballard C, McKeith I, Ince P et al. (1999) White matterlesions on magnetic resonance imaging in dementia with Lewy bodies, Alzheimer’sdisease, vascular dementia, and normal aging. J Neurol Neurosurg Psychiatry 67: 66–72PubMedCrossRefGoogle Scholar
  2. Bogousslavsky J, Regli F, Uske A (1987) Leukoencephalopathy in patients with ischemicstroke. Stroke 18: 896–899PubMedCrossRefGoogle Scholar
  3. Boiten J, Lodder J, Kessels F (1993) Two clinically distinct lacunar infarct entities? Ahypothesis. Stroke 24: 652¡ª656Google Scholar
  4. Bokura H, Kobayashi S, Yamaguchi S (1998) Distinguishing silent lacunar infarctionfrom enlarged Virchow-Robin spaces: a magnetic resonance imaging and pathologi-cal study. J Neurol 245: 116–122PubMedCrossRefGoogle Scholar
  5. Boon A, Lodder J, Heuts-van Raak L, Kessels F (1994) Silent brain infarcts in 755consecutive patients with a first-ever supratentorial ischemic stroke. Relationshipwith index-stroke subtype, vascular risk factors, and mortality. Stroke 25: 2384–2390PubMedCrossRefGoogle Scholar
  6. Breteler MM, van Swieten JC, Bots ML, Grobbee DE, Claus JJ, van den Hout JH, et al.(1994) Cerebral white matter lesions, vascular risk factors, and cognitive function ina population-based study: the Rotterdam Study. Neurology 44: 1246–1252PubMedCrossRefGoogle Scholar
  7. Briley DP, Haroon S, Sergent SM, Thomas S (2000) Does leukoaraiosis predict morbidityand mortality? Neurology 54: 90–94PubMedCrossRefGoogle Scholar
  8. Bryan RN, Wells SW, Miller TJ, Elster AD, Jungreis CA, Poirier VC, et al. (1997)Infarctlike lesions in the brain: prevalence and anatomic characteristics at MR imaging of the elderly-data from the Cardiovascular Health Study. Radiology 202: 47–54PubMedGoogle Scholar
  9. Bryan RN, Cai J, Burke G, Hutchinson RG, Liao D, Toole JF, et al. (1999) Prevalenceand anatomic characteristics of infarct-like lesions on MR images of middle-agedadults: the atherosclerosis risk in communitiesstudy. AJNR Am J Neuroradiol 20:1273–1280PubMedGoogle Scholar
  10. Frequency of white matter lesions and silent lacunar infarcts 37deGroot JC, de LeeuwGoogle Scholar
  11. FE.OudkerkM,van Gijn J, Hofman A, Jolles J, et al. (2000)Cerebral white matter lesions and cognitive function:the Rotterdam Scan Study. AnnNeurol 47: 145–151Google Scholar
  12. de Leeuw FE, de Groot JC, Achten E, Oudkerk M, Ramos LM, Heijboer R, et al. (2001)Prevalence of cerebral white matter lesions in elderly people: a population basedmagnetic resonance imaging study. The Rotterdam Scan Study. J Neurol NeurosurgPsychiatry 70: 9–14CrossRefGoogle Scholar
  13. DeCarli C, Miller BL, Swan GE, Reed T, Wolf PA, Garner J, et al. (1999) Predictors ofbrain morphology for the men of the NHLBI twin study. Stroke 30: 529–536PubMedCrossRefGoogle Scholar
  14. Erkinjuntti T, Ostbye T, Steenhuis R, Hachinski V (1997) The effect of different diagnos-tic criteria on the prevalence of dementia. N Engl J Med 337: 1667–1674PubMedCrossRefGoogle Scholar
  15. Fazekas F, Kleinert R, Offenbacher H, Schmidt R, Kleinert G, Payer F, et al.(1993)Pathologic correlates of incidental MRI white matter signal hyperintensities. Neuro-logy 43: 1683–1689CrossRefGoogle Scholar
  16. Fazekas F, Kapeller P, Schmidt R, Offenbacher H, Payer F, Fazekas G (1996) Therelation of cerebral magnetic resonance signal hyperintensities to Alzheimer’s disease.J Neurol Sci 142:121–125PubMedCrossRefGoogle Scholar
  17. Furuta A,Ishii N, Nishihara Y,Horie A (1991) Medullary arteries in aging and dementia.Stroke 22: 442–446Google Scholar
  18. Herderschee D, Hijdra A, Algra A, Koudstaal PJ, Kappelle LJ, van Gijn J (1992) Silentstroke in patients with transient ischemic attack or minor ischemic stroke. The DutchTIA Trial Study Group. Stroke 23: 1220–1224PubMedCrossRefGoogle Scholar
  19. Hijdra A,Verbeeten B Jr,Verhulst JA (1990) Relation ofleukoaraiosis to lesion type instroke patients. Stroke 21: 890–894PubMedCrossRefGoogle Scholar
  20. Hirono N, Kitagaki H, Kazui H, Hashimoto M, Mori E (2000) Impact of white matterchanges on clinical manifestation of Alzheimer’s disease: a quantitative study. Stroke31: 2182–2188CrossRefGoogle Scholar
  21. Inzitari D, Giordano GP, Ancona AL, Pracucci G, Mascalchi M, Amaducci L,(1990)Leukoaraiosis, intracerebral hemorrhage, and arterial hypertension. Stroke 21: 1419–1423PubMedCrossRefGoogle Scholar
  22. Inzitari D, Cadelo M, Marranci ML, Pracucci G, Pantoni L (1997) Vascular deaths inelderly neurological patients with leukoaraiosis. J Neurol Neurosurg Psychiatry 62:177–181PubMedCrossRefGoogle Scholar
  23. Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS (1995) Leukoaraiosis in strokepatients. The Copenhagen Stroke Study. Stroke 26: 588–592PubMedCrossRefGoogle Scholar
  24. Jungreis CA, Kanal E, Hirsch WL, Martinez AJ, Moossy J (1998) Normal perivascularspaces mimicking lacunar infarction: MR imaging. Radiology 169: 101–104Google Scholar
  25. Kase CS, Wolf PA, Chodosh EH, Zacker HB, Kelly-Hayes M, Kannel WB, et al. (1989)Prevalence of silent stroke in patients presenting with initial stroke: the FraminghamStudy. Stroke 20: 850–852PubMedCrossRefGoogle Scholar
  26. Kobayashi S, Okada K, Koide H, Bokura H, Yamaguchi S (1997) Subcortical silent braininfarction as a risk factor for clinical stroke. Stroke 28: 1932–1939PubMedCrossRefGoogle Scholar
  27. Lammie GA, Brannan F, Slattery J, Warlow C (1997) Nonhypertensive cerebral small-vessel disease. An autopsy study. Stroke 28: 2222–2229PubMedCrossRefGoogle Scholar
  28. Herderschee D, Hijdra A, Algra A, Koudstaal PJ, Kappelle LJ, van Gijn J (1992) Silentstroke in patients with transient ischemic attack or minor ischemic stroke. The DutchTIA Trial Study Group.Stroke 23: 1220–1224PubMedCrossRefGoogle Scholar
  29. Hijdra A, Verbeeten B Jr, Verhulst JA (1990) Relation of leukoaraiosis to lesion type instroke patients. Stroke 21: 890–894PubMedCrossRefGoogle Scholar
  30. Hirono N, Kitagaki H, Kazui H, Hashimoto M, Mori E (2000) Impact of white matterchanges on clinical manifestation of Alzheimer’s disease: a quantitative study. Stroke31: 2182–2188PubMedCrossRefGoogle Scholar
  31. Inzitari D, Giordano GP, Ancona AL, Pracucci G, Mascalchi M, Amaducci L (1990)Leukoaraiosis, intracerebral hemorrhage, and arterial hypertension. Stroke 21: 1419–1423PubMedCrossRefGoogle Scholar
  32. Inzitari D, Cadelo M, Marranci ML, Pracucci G, Pantoni L (1997) Vascular deaths inelderly neurological patients with leukoaraiosis. J Neurol Neurosurg Psychiatry 62:177–181PubMedCrossRefGoogle Scholar
  33. Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS (1995) Leukoaraiosis in strokepatients. The Copenhagen Stroke Study. Stroke 26: 588–592PubMedCrossRefGoogle Scholar
  34. Jungreis CA, Kanal E, Hirsch WL, Martinez AJ, Moossy J (1998) Normal perivascularspaces mimicking lacunar infarction: MR imaging. Radiology 169: 101–104Google Scholar
  35. Kase CS, Wolf PA, Chodosh EH, Zacker HB, Kelly-Hayes M, Kannel WB, et al. (1989)Prevalence of silent stroke in patients presenting with initial stroke: the FraminghamStudy. Stroke 20: 850–852PubMedCrossRefGoogle Scholar
  36. Kobayashi S, Okada K, Koide H, Bokura H, Yamaguchi S (1997) Subcortical silent braininfarction as a risk factor for clinical stroke. Stroke 28: 1932–1939PubMedCrossRefGoogle Scholar
  37. Lammie GA, Brannan F, Slattery J, Warlow C (1997) Nonhypertensive cerebral small-vessel disease. An autopsy study. Stroke 28: 2222–222938Google Scholar
  38. van Dijk E.1,et al.Liao D,Cooper L, Cai J,Toole J,Bryan N,Burke G (1997) The prevalence andseverity of white matter lesions,their relationship with age,ethnicity,gender,andcardiovascular disease risk factors:the ARIC Study.Neuroepidemiology 16:149–162Google Scholar
  39. Lindgren A, Roijer A, Rudling 0, Norrving B, Larsson EM, Eskilsson J, et al. (1994)Cerebral lesions on magnetic resonance imaging, heart disease, and vascular riskfactors in subjects without stroke. A population-based study. Stroke 25: 929–934PubMedCrossRefGoogle Scholar
  40. Longstreth WT, Jr., Manolio TA, Arnold A, Burke GL, Bryan N, Jungreis CA, et al.(1996) Clinical correlates of white matter findings on cranial magnetic resonanceimaging of 3,301 elderly people. The Cardiovascular Health Study. Stroke 27: 1274–1282PubMedCrossRefGoogle Scholar
  41. Longstreth WT, Jr., Bernick C, Manolio TA, Bryan N, Jungreis CA, Price TR (1998)Lacunar infarcts defined by magnetic resonance imaging of 3,660 elderly people: theCardiovascular Health Study. Arch Neurol 55: 1217–1225PubMedCrossRefGoogle Scholar
  42. Mantyla R, Erkinjuntti T, Salonen 0, Aronen HJ, Peltonen T, Pohjasvaara T, et al. (1997)Variable agreement between visual rating scales for white matter hyperintensities onMRI. Comparison of 13 rating scales in a poststroke cohort. Stroke 28: 1614– 1623PubMedCrossRefGoogle Scholar
  43. Mantyla R, Aronen HJ, Salonen 0, Korpelainen M, Peltonen T, Standertskjold-Nordenstam C, et al. (1999a) The prevalence and distribution of white-matterchanges on different MRI pulse sequences in a post-stroke cohort. Neuroradiology 41: 657–665Google Scholar
  44. Mantyla R, Aronen HJ, Salonen 0, Pohjasvaara T, Korpelainen M, Peltonen T, et al.(1999b) Magnetic resonance imaging white matter hyperintensities and mechanism ofischemic stroke. Stroke 30: 2053–2058PubMedCrossRefGoogle Scholar
  45. Miyao S, Takano A, Teramoto J, Takahashi A (1992) Leukoaraiosis in relation to prog-nosis for patients with lacunar infarction. Stroke 23: 1434–1438PubMedCrossRefGoogle Scholar
  46. O’Brien J, Desmond P, Ames D, Schweitzer I, Harrigan S, Tress B (1996) A magneticresonance imaging study of white matter lesions in depression andAlzheimer’sdisease. Br J Psychiatry 168: 477– 485CrossRefGoogle Scholar
  47. Offenbacher H, Fazekas F, Schmidt R, Koch M, Fazekas G, Kapeller P (1996) MR ofcerebral abnormalities concomitant with primary intracerebral hematomas. AJNRAm J Neuroradiol17: 573–578Google Scholar
  48. Pantoni L, Garcia JH (1995) The significance of cerebral white matter abnormalities 100years after Binswanger’s report. A review. Stroke 26: 1293–1301PubMedCrossRefGoogle Scholar
  49. Pantoni L, Garcia JH (1997) Pathogenesis of leukoaraiosis: a review. Stroke 28: 652–659PubMedCrossRefGoogle Scholar
  50. Pohjasvaara T, Mantyla R, Ylikoski R, Kaste M, Erkinjuntti T (2000) Comparison ofdifferent clinical criteria (DSM-III, ADDTC, ICD-10, NINDS-AlREN, DSM-IV) forthe diagnosis of vascular dementia. National Institute of Neurological Disorders andStroke-Association Internationale pour la Recherche et l’Enseignement en Neuro-sciences. Stroke 31: 2952–2957PubMedCrossRefGoogle Scholar
  51. Roman GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH et al.(1993) Vascular dementia: diagnostic criteria for research studies. Report of theNINDS-AIREN International Workshop. Neurology 43: 250–260PubMedCrossRefGoogle Scholar
  52. Scheltens P, Barkhof F, Valk J, Algra PR, van der Hoop RG, Nauta J et al. (1992) Whitematter lesions on magnetic resonance imaging in clinically diagnosed Alzheimer’sdisease. Evidence for heterogeneity. Brain 115: 735–748PubMedCrossRefGoogle Scholar
  53. Scheltens P, Erkinjunti T, Leys D, Wahlund LO, Inzitari D, del Ser T et aI. (1998) Whitematter changes on CT and MRI: an overview of visual rating scales. European TaskForce on Age-Related White Matter Changes. Eur Neurol 39: 8D-89CrossRefGoogle Scholar
  54. Schmidt R, Fazekas F, Kleinert G, Offenbacher H, Gindl K, Payer F et al. (1992)Magnetic resonance imaging signal hyperintensities in the deep and subcortical whitematter. A comparative study between stroke patients and normal volunteers. ArchNeurol 49: 825–827Google Scholar
  55. Schmidt R, Hayn M, Fazekas F, Kapeller P, Esterbauer H (1996) Magnetic resonanceimaging white matter hyperintensities in clinically normal elderly individuals. Corre-Frequency of white matter lesions and silent lacunar infarcts 39lations with plasma concentrations of naturally occurring antioxidants. Stroke 27:2043–2047PubMedCrossRefGoogle Scholar
  56. Schmidt R, Fazekas F, Hayn M, Schmidt H, Kapeller P, Roob G, et al. (1997) Risk factorsfor microangiopathy-related cerebral damage in the Austrian stroke preventionstudy. J Neurol Sci 152: 15–21PubMedCrossRefGoogle Scholar
  57. Schmidt R, Fazekas F, Kapeller P, Schmidt H, Hartung HP (1999) MRI white matterhyperintensities: three-year follow-up of the Austrian Stroke Prevention Study.Neurology 53: 132–139CrossRefGoogle Scholar
  58. Shimada K, Kawamoto A, Matsubayashi K, Ozawa T (1990) Silent cerebrovasculardisease in the elderly. Correlation with ambulatory pressure. Hypertension 16: 692–699PubMedCrossRefGoogle Scholar
  59. Tarvonen-Schroder S, Kurki T, Raiha I, Sourander L (1995) Leukoaraiosis and cause ofdeath: a five year follow up. J Neurol Neurosurg Psychiatry 58: 586–589PubMedCrossRefGoogle Scholar
  60. van Swieten JC, van den Hout JH, van Ketel BA, Hijdra A, Wokke JH, van Gijn J (1991)Periventricular lesions in the white matter on magnetic resonance imaging in theelderly. A morphometric correlation with arteriolosclerosis and dilated perivascularspaces. Brain 114: 761–774PubMedCrossRefGoogle Scholar
  61. van Swieten JC, Kappelle LJ, Algra A, van Latum JC, Koudstaal PJ, van Gijn J (1992)Hypodensity of the cerebral white matter in patients with transient ischemic attackor minor stroke: influence on the rate of subsequent stroke. Dutch TIA Trial StudyGroup. Ann Neurol 32: 177–183PubMedCrossRefGoogle Scholar
  62. van Zagten M, Boiten J, Kessels F, Lodder J (1996) Significant progression of whitematter lesions and small deep (lacunar) infarcts in patients with stroke. Arch Neurol53: 650– 655Google Scholar
  63. Vermeer SE, Koudstaal PJ, Oudkerk M, Hofman A, BretelerMM (2002) Prevalence andrisk factors of silent brain infarcts in the population-based Rotterdam Scan Study.Stroke 33: 21–25Google Scholar
  64. WaWund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjogren M et al. (2001) Anew rating scale for age-related white matter changes applicable to MRI and CT.Stroke 32: 1318–1322CrossRefGoogle Scholar
  65. Waldemar G, Christiansen P, Larsson HB, Hogh P, Laursen H, Lassen NA et al. (1994)White matter magnetic resonance hyperintensities in dementia of the Alzheimertype: morphological and regional cerebral blood flow correlates. J Neurol NeurosurgPsychiatry 57: 1458–1465CrossRefGoogle Scholar
  66. Whitman GT, Tang T, Lin A, Baloh RW (2001) A prospective study of cerebral whitematter abnormalities in older people with gait dysfunction. Neurology 57: 990–994PubMedCrossRefGoogle Scholar
  67. Wiszniewska M, Devuyst G, Bogousslavsky J, Ghika J, van Melle G (2000) What is thesignificance of leukoaraiosis in patients with acute ischemic stroke? Arch Neurol57:967–973CrossRefGoogle Scholar
  68. Ylikoski A, Erkinjuntti T, Raininko R, Sarna S, Sulkava R, Tilvis R (1995) White matterhyperintensities on MRI in the neurologically nondiseased elderly. Analysis ofcohorts of consecutive subjects aged 55 to 85 years living at home. Stroke 26: 1171–1177PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2002

Authors and Affiliations

  • E. J. van Dijk
    • 1
    • 2
  • N. D. Prins
    • 1
    • 2
  • S. E. Vermeer
    • 1
    • 2
  • P. J. Koudstaaf
    • 2
  • M. M. B. Breteler
    • 1
  1. 1.Department of Epidemiology and BiostatisticsErasmus Medical CenterRotterdamThe Netherlands
  2. 2.Department of NeurologyRotterdamRotterdamThe Netherlands

Personalised recommendations