A comparison of location of acute symptomatic vs. 'silent' small vessel lesions

Maria del C Valdes Hernandez, Lucy C Maconick, Susana Munoz Maniega, Xin Wang, Stuart Wiseman, Paul A Armitage, Fergus N Doubal, Stephen Makin, Cathie L Sudlow, Martin s Dennis, Ian J Deary, Mark Bastin, Joanna M Wardlaw

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Acute lacunar ischaemic stroke, white matter hyperintensities, and lacunes are all features of cerebral small vessel disease. It is unclear why some small vessel disease lesions present with acute stroke symptoms, whereas others typically do not. AIM: To test if lesion location could be one reason why some small vessel disease lesions present with acute stroke, whereas others accumulate covertly. METHODS: We identified prospectively patients who presented with acute lacunar stroke symptoms with a recent small subcortical infarct confirmed on magnetic resonance diffusion imaging. We compared the distribution of the acute infarcts with that of white matter hyperintensity and lacunes using computational image mapping methods. RESULTS: In 188 patients, mean age 67 +/- standard deviation 12 years, the lesions that presented with acute lacunar ischaemic stroke were located in or near the main motor and sensory tracts in (descending order): posterior limb of the internal capsule (probability density 0.2/mm(3)), centrum semiovale (probability density = 0.15/mm(3)), medial lentiform nucleus/lateral thalamus (probability density = 0.09/mm(3)), and pons (probability density = 0.02/mm(3)). Most lacunes were in the lentiform nucleus (probability density = 0.01-0.04/mm(3) ) or external capsule (probability density = 0.05/mm(3)). Most white matter hyperintensities were in centrum semiovale (except for the area affected by the acute symptomatic infarcts), external capsules, basal ganglia, and brainstem, with little overlap with the acute symptomatic infarcts (analysis of variance, P <0.01). CONCLUSIONS: Lesions that present with acute lacunar ischaemic stroke symptoms may be more likely noticed by the patient through affecting the main motor and sensory tracts, whereas white matter hyperintensity and asymptomatic lacunes mainly affect other areas. Brain location could at least partly explain the symptomatic vs. covert development of small vessel disease.
Original languageEnglish
Pages (from-to)1044-1050
Number of pages7
JournalInternational Journal of Stroke
Volume10
Issue number7
Early online date29 Jun 2015
DOIs
Publication statusPublished - Oct 2015

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Lacunar Stroke
Corpus Striatum
Stroke
Cerebral Small Vessel Diseases
Internal Capsule
Diffusion Magnetic Resonance Imaging
Pons
Basal Ganglia
Thalamus
Brain Stem
Analysis of Variance
Extremities
White Matter
Brain
External Capsule

Keywords

  • Aged Aged, 80 and over Analysis of Variance Brain/*pathology Cerebral Infarction/*pathology Cerebral Small Vessel Diseases/*pathology/*physiopathology Female Humans Image Processing, Computer-Assisted Magnetic Resonance Imaging Male Middle Aged Retrospective Studies Stroke/pathology acute lacunar infarct lacunar stroke lacunes small vessel disease stroke white matter hyperintensities

Cite this

Valdes Hernandez, M. D. C., Maconick, L. C., Munoz Maniega, S., Wang, X., Wiseman, S., Armitage, P. A., ... Wardlaw, J. M. (2015). A comparison of location of acute symptomatic vs. 'silent' small vessel lesions. International Journal of Stroke, 10(7), 1044-1050. https://doi.org/10.1111/ijs.12558

A comparison of location of acute symptomatic vs. 'silent' small vessel lesions. / Valdes Hernandez, Maria del C; Maconick, Lucy C; Munoz Maniega, Susana; Wang, Xin; Wiseman, Stuart; Armitage, Paul A; Doubal, Fergus N; Makin, Stephen ; Sudlow, Cathie L; Dennis, Martin s; Deary, Ian J; Bastin, Mark; Wardlaw, Joanna M.

In: International Journal of Stroke, Vol. 10, No. 7, 10.2015, p. 1044-1050.

Research output: Contribution to journalArticle

Valdes Hernandez, MDC, Maconick, LC, Munoz Maniega, S, Wang, X, Wiseman, S, Armitage, PA, Doubal, FN, Makin, S, Sudlow, CL, Dennis, MS, Deary, IJ, Bastin, M & Wardlaw, JM 2015, 'A comparison of location of acute symptomatic vs. 'silent' small vessel lesions', International Journal of Stroke, vol. 10, no. 7, pp. 1044-1050. https://doi.org/10.1111/ijs.12558
Valdes Hernandez MDC, Maconick LC, Munoz Maniega S, Wang X, Wiseman S, Armitage PA et al. A comparison of location of acute symptomatic vs. 'silent' small vessel lesions. International Journal of Stroke. 2015 Oct;10(7):1044-1050. https://doi.org/10.1111/ijs.12558
Valdes Hernandez, Maria del C ; Maconick, Lucy C ; Munoz Maniega, Susana ; Wang, Xin ; Wiseman, Stuart ; Armitage, Paul A ; Doubal, Fergus N ; Makin, Stephen ; Sudlow, Cathie L ; Dennis, Martin s ; Deary, Ian J ; Bastin, Mark ; Wardlaw, Joanna M. / A comparison of location of acute symptomatic vs. 'silent' small vessel lesions. In: International Journal of Stroke. 2015 ; Vol. 10, No. 7. pp. 1044-1050.
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abstract = "BACKGROUND: Acute lacunar ischaemic stroke, white matter hyperintensities, and lacunes are all features of cerebral small vessel disease. It is unclear why some small vessel disease lesions present with acute stroke symptoms, whereas others typically do not. AIM: To test if lesion location could be one reason why some small vessel disease lesions present with acute stroke, whereas others accumulate covertly. METHODS: We identified prospectively patients who presented with acute lacunar stroke symptoms with a recent small subcortical infarct confirmed on magnetic resonance diffusion imaging. We compared the distribution of the acute infarcts with that of white matter hyperintensity and lacunes using computational image mapping methods. RESULTS: In 188 patients, mean age 67 +/- standard deviation 12 years, the lesions that presented with acute lacunar ischaemic stroke were located in or near the main motor and sensory tracts in (descending order): posterior limb of the internal capsule (probability density 0.2/mm(3)), centrum semiovale (probability density = 0.15/mm(3)), medial lentiform nucleus/lateral thalamus (probability density = 0.09/mm(3)), and pons (probability density = 0.02/mm(3)). Most lacunes were in the lentiform nucleus (probability density = 0.01-0.04/mm(3) ) or external capsule (probability density = 0.05/mm(3)). Most white matter hyperintensities were in centrum semiovale (except for the area affected by the acute symptomatic infarcts), external capsules, basal ganglia, and brainstem, with little overlap with the acute symptomatic infarcts (analysis of variance, P <0.01). CONCLUSIONS: Lesions that present with acute lacunar ischaemic stroke symptoms may be more likely noticed by the patient through affecting the main motor and sensory tracts, whereas white matter hyperintensity and asymptomatic lacunes mainly affect other areas. Brain location could at least partly explain the symptomatic vs. covert development of small vessel disease.",
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T1 - A comparison of location of acute symptomatic vs. 'silent' small vessel lesions

AU - Valdes Hernandez, Maria del C

AU - Maconick, Lucy C

AU - Munoz Maniega, Susana

AU - Wang, Xin

AU - Wiseman, Stuart

AU - Armitage, Paul A

AU - Doubal, Fergus N

AU - Makin, Stephen

AU - Sudlow, Cathie L

AU - Dennis, Martin s

AU - Deary, Ian J

AU - Bastin, Mark

AU - Wardlaw, Joanna M

N1 - Valdes Hernandez, Maria del C Maconick, Lucy C Munoz Maniega, Susana Wang, Xin Wiseman, Stewart Armitage, Paul A Doubal, Fergus N Makin, Stephen Sudlow, Cathie L M Dennis, Martin S Deary, Ian J Bastin, Mark Wardlaw, Joanna M eng 075611/Wellcome Trust/United Kingdom G1001245/Medical Research Council/United Kingdom MR/K026992/1/Medical Research Council/United Kingdom G0701120/Medical Research Council/United Kingdom 063668/Wellcome Trust/United Kingdom WT088134/Z/09/A/Wellcome Trust/United Kingdom 217NTU R37933/Chief Scientist Office/United Kingdom Research Support, Non-U.S. Gov't 2015/06/30 06:00 Int J Stroke. 2015 Oct;10(7):1044-50. doi: 10.1111/ijs.12558. Epub 2015 Jun 29.

PY - 2015/10

Y1 - 2015/10

N2 - BACKGROUND: Acute lacunar ischaemic stroke, white matter hyperintensities, and lacunes are all features of cerebral small vessel disease. It is unclear why some small vessel disease lesions present with acute stroke symptoms, whereas others typically do not. AIM: To test if lesion location could be one reason why some small vessel disease lesions present with acute stroke, whereas others accumulate covertly. METHODS: We identified prospectively patients who presented with acute lacunar stroke symptoms with a recent small subcortical infarct confirmed on magnetic resonance diffusion imaging. We compared the distribution of the acute infarcts with that of white matter hyperintensity and lacunes using computational image mapping methods. RESULTS: In 188 patients, mean age 67 +/- standard deviation 12 years, the lesions that presented with acute lacunar ischaemic stroke were located in or near the main motor and sensory tracts in (descending order): posterior limb of the internal capsule (probability density 0.2/mm(3)), centrum semiovale (probability density = 0.15/mm(3)), medial lentiform nucleus/lateral thalamus (probability density = 0.09/mm(3)), and pons (probability density = 0.02/mm(3)). Most lacunes were in the lentiform nucleus (probability density = 0.01-0.04/mm(3) ) or external capsule (probability density = 0.05/mm(3)). Most white matter hyperintensities were in centrum semiovale (except for the area affected by the acute symptomatic infarcts), external capsules, basal ganglia, and brainstem, with little overlap with the acute symptomatic infarcts (analysis of variance, P <0.01). CONCLUSIONS: Lesions that present with acute lacunar ischaemic stroke symptoms may be more likely noticed by the patient through affecting the main motor and sensory tracts, whereas white matter hyperintensity and asymptomatic lacunes mainly affect other areas. Brain location could at least partly explain the symptomatic vs. covert development of small vessel disease.

AB - BACKGROUND: Acute lacunar ischaemic stroke, white matter hyperintensities, and lacunes are all features of cerebral small vessel disease. It is unclear why some small vessel disease lesions present with acute stroke symptoms, whereas others typically do not. AIM: To test if lesion location could be one reason why some small vessel disease lesions present with acute stroke, whereas others accumulate covertly. METHODS: We identified prospectively patients who presented with acute lacunar stroke symptoms with a recent small subcortical infarct confirmed on magnetic resonance diffusion imaging. We compared the distribution of the acute infarcts with that of white matter hyperintensity and lacunes using computational image mapping methods. RESULTS: In 188 patients, mean age 67 +/- standard deviation 12 years, the lesions that presented with acute lacunar ischaemic stroke were located in or near the main motor and sensory tracts in (descending order): posterior limb of the internal capsule (probability density 0.2/mm(3)), centrum semiovale (probability density = 0.15/mm(3)), medial lentiform nucleus/lateral thalamus (probability density = 0.09/mm(3)), and pons (probability density = 0.02/mm(3)). Most lacunes were in the lentiform nucleus (probability density = 0.01-0.04/mm(3) ) or external capsule (probability density = 0.05/mm(3)). Most white matter hyperintensities were in centrum semiovale (except for the area affected by the acute symptomatic infarcts), external capsules, basal ganglia, and brainstem, with little overlap with the acute symptomatic infarcts (analysis of variance, P <0.01). CONCLUSIONS: Lesions that present with acute lacunar ischaemic stroke symptoms may be more likely noticed by the patient through affecting the main motor and sensory tracts, whereas white matter hyperintensity and asymptomatic lacunes mainly affect other areas. Brain location could at least partly explain the symptomatic vs. covert development of small vessel disease.

KW - Aged Aged, 80 and over Analysis of Variance Brain/pathology Cerebral Infarction/pathology Cerebral Small Vessel Diseases/pathology/physiopathology Female Humans Image Processing, Computer-Assisted Magnetic Resonance Imaging Male Middle Aged Retrospective

U2 - 10.1111/ijs.12558

DO - 10.1111/ijs.12558

M3 - Article

VL - 10

SP - 1044

EP - 1050

JO - International Journal of Stroke

JF - International Journal of Stroke

SN - 1747-4930

IS - 7

ER -