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White Matter Hyperintensity-Associated Blood-Brain Barrier Disruption and Vascular Risk Factors
Nidhi Gupta1, Alexis N Simpkins1, Emi Hitomi1
1Neuro Vascular Brain Imaging Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.
Background:
White matter hyperintensities (WMH), the hallmark of vascular cognitive impairment, are associated with vascular risk factors (VRF). WMH can also be associated with blood-brain barrier (BBB) disruption. The purpose of this study was to look for associations between VRF and BBB disruption in stroke patients with WMH.
Methods:
Magnetic resonance images of stroke patients were reviewed for the presence of WMH. Blood-brain permeability images were retrospectively generated. The degree of BBB permeability was compared with the presence of VRF using logistic regression. Patterns and extent of WMH were classified using Fazekas scores.
Results:
Sixty-five patients were included in this study. None of the VRF tested were associated with an increase in BBB disruption. Hypertension was significantly associated with less BBB disruption (P = .04). Nonhypertensive patients in our study had a different pattern of WMH than hypertensive patients, with less involvement of the periventricular white matter.
Conclusions:
We found that in stroke patients with WMH, those with hypertension had less BBB disruption and greater involvement of the periventricular white matter when compared with patients who did not have a history of hypertension. Further investigation is needed to determine if the development of WMH in stroke patients with a history of hypertension has a different pathophysiology from patients who develop WMH in the absence of hypertension.
Insights
In stroke patients with white matter hyperintensities (WMH), hypertension was linked to reduced blood-brain barrier (BBB) disruption. This suggests a distinct WMH development pathway in hypertensive individuals.
Area of Science:
- Neurology
- Neuroimaging
- Vascular Dementia
Background:
- White matter hyperintensities (WMH) are key indicators of vascular cognitive impairment.
- WMH are linked to vascular risk factors (VRF) and blood-brain barrier (BBB) disruption.
- Understanding the relationship between VRF, BBB, and WMH is crucial in stroke patients.
Purpose of the Study:
- To investigate associations between VRF and BBB disruption in stroke patients with WMH.
- To explore how hypertension specifically impacts BBB permeability and WMH patterns.
Main Methods:
- Retrospective analysis of MRI scans from stroke patients with WMH.
- Generation of blood-brain permeability images.
- Logistic regression analysis to compare BBB permeability with VRF, using Fazekas scores for WMH classification.
Main Results:
- No tested VRF were associated with increased BBB disruption.
- Hypertension showed a significant association with *less* BBB disruption (P=.04).
- Non-hypertensive patients exhibited different WMH patterns, with less periventricular white matter involvement.
Conclusions:
- Hypertensive stroke patients with WMH demonstrated less BBB disruption and more periventricular involvement compared to non-hypertensives.
- The pathophysiology of WMH may differ between hypertensive and non-hypertensive stroke patients.
- Further research is warranted to elucidate these distinct WMH development pathways.
