뇌졸중 환자에서 관찰되는 대뇌백질변성과 이에 관련된 위험인자 = Risk Factors of Cerebral White Matter Change in Patients with Stroke

다국어 초록 (Multilingual Abstract)

Background:Cerebral white matter change (WMC) is usually seen in stroke patients. This study was aimed at determining whether there might be a relationship between the extent of WMC and whether to control hypertension or not and the frequency of previous stroke lesion. Stroke subtypes were also analyzed to elucidate WMC distribution. Methods:We investigated demographic features, vascular risk factors, subtypes, and WMC in 339 ischemic stroke patients over forty years of age who had brain MRI from the Hallym Stroke Registry between January 1998 and December 2001. In hypertension, it was divided into with therapy and with no therapy. In frequency of previous stroke lesion, we subdivided the patients into three groups by number of frequency: 0, 1, and ≥2. Stroke subtypes were classified into large artery atherosclerosis (LAA), small artery occlusion (SAO), cardioembolism (CE), and stroke of undetermined etiology (SUE). WMC was quantitatively estimated by subdividing into 5 grades (0~IV). Results:Age, female, hypertension, previous stroke lesion, and SAO correlated significantly with prevalence of WMC (p<0.001, =0.002, <0.001, <0.001 and <0.001, respectively). In hypertension, there was significant difference between normotensive and hypertensive (p=0.001). But there was no statistical difference between with therapy and with no therapy (p>0.05). In previous stroke lesion, it showed significant difference between 0 and (1 and ≥2) (p<0.001) and between 1 and ≥2 (p<0.001). In subtype, CE also correlated significantly with prevalence of WMC as well as SAO than LAA (p<0.001). Conclusions:WMC seen in patients with stroke is related with small-vessel disease and is mainly affected by age, female, hypertension, and previous stroke lesion.

참고문헌 (Reference)

1 "White matter changes in stroke and fibrinogen levels [abstract]" 34 : 260-, 1993

2 "Variables associated with fibrinogen in a population-based study: interaction between smoking and age on fibrinogen concentration" 17 : 953-958, 2001

3 "Variability in midlife systolic blood pressure is related to late-life brain white matter lesions:the Honolulu-Asia Aging Study" 33 : 26-30, 2002

4 "Urinary function in elderly people with and without leukoaraiosis:relation to cognitive and gait function" 67 : 658-660, 1999

5 "The frequency of leukoaraiosis in diabetes mellitus and hypertension;the quantitative correlation of leukoaraiosis and its risk factors" 10 : 502-508, 1992

6 "Subcortical hypoperfusion associated with asymptomatic white matter lesions on magnetic resonance imaging" 28 : 1944-1947, 1997

7 "Silent cerebral microbleeds on T2*-weighted MRI: correlation with stroke subtype, stroke recurrence, and leukoaraiosis" 33 : 1536-1540, 2002

8 "Selective reduction of blood flow to white matter during hypotension in newborn dogs: a possible mechanism of periventricular leukomalacia" 12 : 445-448, 1982

9 "Relationship of leukoaraiosis with cerebrovascular disease" 9 : 302-308, 1991

10 "Relation of leukoaraiosis to lesion type in stroke patients" 21 : 890-894, 1990

11 "Reduced cerebral blood flow in white matter in ischaemic leukoaraiosis demonstrated using quantitative exogenous contrast based perfusion MRI" 69 : 48-53, 2000

12 "Periventricular white matter lucency and cerebral blood flow autoregulation in hypertensive patients" 23 : 565-568, 1994

13 "Patterns of cerebral blood flow reduction in patients with ischemic leukoaraiosis" 59 : 321-326, 2002

14 "Pathogenesis of leukoaraiosis" 28 : 652-659, 1997

15 "Nocturnal fall of blood pressure and silent cerebrovascular damage in elderly hypertensive patients. Advanced silent cerebrovascular damage in extreme dippers" 27 : 130-135, 1996

16 "Magnetic resonance imaging signal hyperintensities in the deep and subcortical white matter. A comparative study between stroke patients and normal volunteers" 49 : 825-827, 1992

17 "Lipoprotein(a)as a risk factor for cerebrovascular disease and dementia" 5 : 17-22, 1995

18 "Leukoaraiosis: an independent risk factor for stroke" 34 : 2067-2071, 2003

19 "Leukoaraiosis in stroke patients.The Copenhagen Stroke Study" 26 : 588-592, 1995

20 "Hypoperfusion in the aetiology of subcortical arteriosclerotic encephalopathy(Binswanger type)" 47 : 754-, 1984

21 "Hyperhomocyst(e)inemia and risk of ischemic stroke among young asian adults" 33 : 1956-1962, 2002

22 "Homocysteine and vascular disease" 354 : 407-413, 1999

23 "Higher lipoprotein(a)levels in atherothrombotic than lacunar ischemic cerebrovascular disease" 58 : 653-655, 2002

24 "Fibrinogen depleting agents in ischemic stroke" 1 : 1-6, 1999

25 "Evolving concepts of white matter diseases" 2 : 137-143, 2000

26 "Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge" 18 : 499-502, 1972

27 "Effects on coronary artery disease of lipid- lowering diet or diet plus cholestyramin in the St Thomas' Atherosclerosis Regression Study" 339 : 563-569, lancet1992

28 "Differences between treated and untreated hypertensive subjects in the extent of periventricular hyperintensities observed on brain MRI" 26 : 1593-1597, 1995

29 "Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people.The Cardiovascular Health Study" 27 : 1274-1282, 1996

30 "Classification of subtype of acute ischemic stroke. Definitions for use in multicenter clinical trial. TOAST. Trial of Org 10,172 in Acute Stroke Treatment" 24 : 35-41, 1993

31 "Cigarette smoking is correlated with the periventricular hyperintensity grade of brain magnetic resonance imaging" 27 : 645-649, 1996

32 "Cerebral white matter lesions and hypertension type:the Ansan study" 1 : 107-112, 2002

33 "Cerebral perfusion and cerebrovascular reactivity are reduced in white matter hyperintensities" 33 : 972-976, 2002

34 "Cerebral lesions on magnetic resonance imaging, heart disease, and vascular risk factors in subjects without stroke" 25 : 929-934, 1994

35 "Cerebral blood flow, cerebral blood flow reactivity to acetazolamide, and cerebral blood volume in patients with leukoaraiosis" 4 : 287-293, 1994

36 "Caplan.Bingswangers disease-revisited" 45 : 626-633, 1995

37 "Atrial fibrillation and the risk of cerebral white matter lesions" 54 : 1795-1801, 2000

38 "An autopsy case of Bingswanger's disease without hypertension and associated with cerebral infarction in the terminal stage" 47 : 901-907, 1993

39 "Ambulatory blood pressure monitoring in acute stroke.The West Birmingham Stroke Project" 28 : 31-35, 1997

40 "Ambulatory blood pressure monitoring in acute stroke.The West Birmingham Stroke Project" 28 : 31-35, 1997

41 "Acute and long-term changes in serum lipids after acute stroke" 21 : 1407-1411, 1990

42 "A review on blood pressure and ischaemic white matter lesions" 9 (9): 13-19, 1998

43 "A prospective study of cerebral artery atherosclerosis" 19 : 820-825, 1988

44 "24-hour blood pressure monitoring in chronic cerebrovascular disease;decreased nocturnal blood pressure dip" 14 : 921-929, 1996