White matter hyperintensity reduction and outcomes after minor stroke.

Area of Science:

• Neurology
• Neuroimaging
• Stroke Research

Background:

• White matter hyperintensities (WMH) are common after minor ischemic strokes.
• Previous observations noted WMH shrinkage in some patients, prompting further investigation.

Purpose of the Study:

• To identify factors associated with changes in white matter hyperintensity (WMH) volume one year after a minor ischemic stroke.
• To explore the relationship between WMH changes and clinical outcomes, including recurrent cerebrovascular events and dependency.

Main Methods:

• A cohort of 190 participants with minor ischemic stroke underwent clinical assessments and brain MRI at baseline and 1 year.
• Changes in WMH volume (normalized to intracranial volume) were assessed.
• Multivariable analyses examined associations with baseline variables, clinical outcomes, and imaging parameters.

Main Results:

• WMH volume decreased in 71 participants within one year.
• Baseline higher blood pressure was associated with WMH decrease.
• WMH decrease correlated with greater reductions in blood pressure and mean diffusivity in normal-appearing white matter.
• WMH increase was linked to a higher incidence of recurrent cerebrovascular events.

Conclusions:

• White matter hyperintensity regression is possible after minor stroke, potentially linked to better clinical and brain tissue health.
• Risk factor control, such as blood pressure management, may play a crucial role in WMH reversibility.
• Interstitial fluid dynamics are a potential mechanism for WMH regression and future therapeutic targets.