Association between cerebrovasoreactivity and stroke in cerebral autosomal dominant arteriopathy with subcortical
Mao Mukai1, Ai Hamano1, Ikuko Mizuta1
1Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Insights
Impaired thalamic cerebrovasoreactivity is linked to stroke in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) patients. This finding highlights the thalamus as a key area for understanding stroke risk in CADASIL.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is associated with impaired cerebrovasoreactivity.
- Understanding the link between cerebrovasoreactivity and stroke is crucial for CADASIL pathophysiology.
Purpose of the Study:
- To investigate the association between cerebrovascular reactivity and stroke in patients diagnosed with CADASIL.
- To identify specific regional cerebral blood flow (rCBF) alterations related to stroke occurrence in CADASIL.
Main Methods:
- Retrospective study of 14 CADASIL patients, with 8 experiencing symptomatic stroke.
- Quantitative single-photon emission computed tomography (SPECT) with acetazolamide (ACZ) challenge to assess regional cerebral blood flow (rCBF).
- Comparison of rCBF parameters at rest and post-ACZ between CADASIL patients with and without stroke.
Main Results:
- Patients with stroke showed significantly lower acetazolamide-challenged rCBF in the thalamus (35.6 ± 9.4 mL/100 g/min) compared to those without stroke (51.1 ± 7.6 mL/100 g/min; p=0.01).
- A significantly reduced thalamic ΔrCBF (10.6 ± 3.7 vs. 21.0 ± 7.9; p=0.02) was observed in stroke patients.
- Elevated pyramidal tract signs and a higher number of old lacunes were noted in stroke patients.
Conclusions:
- Thalamic cerebrovasoreactivity is significantly associated with the presence of stroke in CADASIL patients.
- Impaired thalamic blood flow regulation may be a key factor in stroke development within the CADASIL population.
Background:
Impaired cerebrovasoreactivity is thought to play an important role in the pathophysiology of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). We aimed to clarify the association between cerebrovascular reactivity and stroke in patients with CADASIL.
Methods:
We retrospectively recruited 14 patients with CADASIL, eight of whom had symptomatic stroke. They underwent quantitative single-photon emission computed tomography using an autoradiographic method at rest and after acetazolamide (ACZ) administration. Regional cerebral blood flow (rCBF) in the cerebral cortex, lenticular nucleus, thalamus, and cerebellum was measured. We compared the rCBF parameters between patients with and without stroke.
Results:
The baseline characteristics and magnetic resonance imaging findings were similar between the two groups, except for a higher frequency of pyramidal tract sign (75% vs. 0%) and a larger number of old lacunes (15.4 ± 8.8 vs. 2.2 ± 1.8) in the patients with stroke. Of the rCBF parameters measured, significantly lower flow (mL/100 g/min) was observed in ACZ-rCBF in the thalamus (35.6 ± 9.4 vs. 51.1 ± 7.6, p = 0.01) and ΔrCBF in the thalamus (10.6 ± 3.7 vs. 21.0 ± 7.9, p = 0.02) in the patients with stroke.
Conclusion:
Cerebrovasoreactivity in the thalamus was significantly associated with stroke in patients with CADASIL.
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