White matter hyperintensity (WMH) may be a marker of an underlying cerebral microangiopathy. Therefore, we hypothesized that WMH would be most severe in patients with lacunar stroke and intracerebral hemorrhage (ICH), 2 types of stroke in which cerebral small vessel (SV) changes are pathophysiologically relevant.
We determined WMH volume (WMHV) in cohorts of prospectively ascertained patients with acute ischemic stroke (AIS) (Massachusetts General Hospital [MGH], n = 628, and the Ischemic Stroke Genetics Study [ISGS], n = 263) and ICH (MGH, n = 122).
Median WMHV was 7.5 cm3 (interquartile range 3.4–14.7 cm3) in the MGH AIS cohort (mean age 65 ± 15 years). MGH patients with larger WMHV were more likely to have lacunar stroke compared with cardioembolic (odds ratio [OR] = 1.87 per SD normally transformed WMHV), large artery (OR = 2.25), undetermined (OR = 1.87), or other (OR = 1.85) stroke subtypes (p < 0.03). These associations were replicated in the ISGS cohort (p = 0.03). In a separate analysis, greater WMHV was seen in ICH compared with lacunar stroke (OR = 1.2, p < 0.02) and in ICH compared with all ischemic stroke subtypes combined (OR = 1.34, p < 0.007).
Greater WMH burden was associated with SV stroke compared with other ischemic stroke subtypes and, even more strongly, with ICH. These data, from 2 independent samples, support the model that increasing WMHV is a marker of more severe cerebral SV disease and provide further evidence for links between the biology of WMH and SV stroke.
|AF||= atrial fibrillation;|
|AIS||= acute ischemic stroke;|
|CAD||= coronary artery disease;|
|CI||= confidence interval;|
|DM||= diabetes mellitus;|
|DWI||= diffusion-weighted imaging;|
|FLAIR||= fluid-attenuated inversion recovery;|
|ICA||= intracranial area;|
|ICC||= intraclass correlation coefficient;|
|ICH||= intracerebral hemorrhage;|
|IQR||= interquartile range;|
|ISGS||= Ischemic Stroke Genetics Study;|
|MGH||= Massachusetts General Hospital;|
|OR||= odds ratio;|
|SV||= small vessel;|
|TOAST||= Trial of Org 10172 in Acute Stroke Treatment;|
|WMH||= white matter hyperintensity;|
|WMHV||= white matter hyperintensity volume.|