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February 1, 1999

Cerebral vasomotor reactivity and cerebral white matter lesions in the elderly

February 1, 1999 issue
52 (3) 578

Abstract

Objective: The pathogenesis of white matter lesions is still uncertain, but an ischemic-hypoxic cause has been suggested. Cerebral vasomotor reactivity reflects the compensatory dilatory mechanism of the intracerebral arterioles to a vasodilatory stimulus and provides a more sensitive hemodynamic index than the level of resting flow.
Methods: The authors determined the association between vasomotor reactivity and white matter lesions in 73 consecutive individuals from the Rotterdam Scan Study who also participated in the Rotterdam Study, a large population-based prospective follow-up study of individuals ≥55 years old. Vasomotor reactivity was measured by means of CO2-enhanced transcranial Doppler, and in all individuals axial T1*-, T2*-, and proton density (PD)-weighted MRI scans (1.5 T) were obtained. White matter lesions were scored according to location, size, and number by two independent readers.
Results: Vasomotor reactivity was inversely associated with the deep subcortical and total periventricular white matter lesions (OR 0.5, 95% CI 0.3 to 1.1; and OR 0.7, 95% CI 0.4 to 1.1, respectively). A strong association was found between impaired vasomotor reactivity and periventricular white matter lesions adjacent to the lateral ventricular wall (OR 0.6, 95% CI 0.4 to 1.0; p = 0.001). No association was found with periventricular white matter lesions near the frontal and occipital horns.
Conclusions: Our data confirm the association between vasomotor reactivity and white matter lesions and support the hypothesis that some white matter lesions may be associated with hemodynamic ischemic injury to the brain.

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References

1.
Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. Am J Roentgenol 1987;149:351–356.
2.
George AE, De Leon MJ, Gentes CI, et al. Leukoencephalopathy in normal and pathologic aging : 1. CT of brain lucencies. Am J Neuroradiol 1986;7:561–566.
3.
Lechner H, Schmidt R, Bertha G, Justich E, Offenbacher H, Schneider G. Nuclear magnetic resonance image white matter lesions and risk factors for stroke in normal individuals. Stroke 1988;19:263–265.
4.
Fazekas F, Niederkorn K, Schmidt R, et al. White matter signal abnormalities in normal individuals : correlation with carotid ultrasonography, cerebral blood flow measurements, and cerebrovascular risk factors. Stroke 1988;19:1285–1288.
5.
Awad IA, Johnson PC, Spetzler RF, Hodak JA. Incidental subcortical lesions identified on magnetic resonance imaging in the elderly. II. Postmortem pathological correlations. Stroke 1986;17:1090–1097.
6.
Kirkpatrick JB, Hayman LA. White-matter lesions in MR imaging of clinically healthy brains of elderly subjects : possible pathologic basis. Radiology 1987;162:509–511.
7.
Pantoni L, Garcia JH. Pathogenesis of leukoaraiosis. A review. Stroke 1997;28:652–659.
8.
Brucher JM. Leukoencephalopathy in anoxic-ischemic processes. In: Koetsier JC, ed. Handbook of clinical neurology. Vol. 3: Demyelinating diseases. Amsterdam: Elsevier Science Publishers BV, 1985:525–549.
9.
Ginsberg MD, Hedley-Whyte ET, Richardson EP. Hypoxic-ischemic leukoencephalopathy in man. Arch Neurol 1976;33:5–14.
10.
Hatazawa J, Shimosegawa E, Satoh T, Toyoshima H, Okudera T. Subcortical hypoperfusion associated with asymptomatic white matter lesions on magnetic resonance imaging. Stroke 1997;28:1944–1947.
11.
Diehl RR, Berlit P. Dopplerfunktionstests. In: Funktionelle Dopplersonographie in der Neurologie. Berlin, Heidelberg:Springer-Verlag, 1996:41–78.
12.
Vorstrup S. Tomographic cerebral blood flow measurements in patients with ischemic cerebrovascular disease and evaluation of the vasodilatory capacity by the acetazolamide test. Acta Neurol Scand 1988;114 (suppl):1–48.
13.
Widder B, Kleiser B, Krapf H. Course of cerebrovascular reactivity in patients with carotid artery occlusions. Stroke 1994;25:1963–1967.
14.
Hartl WH, Janssen I, Fürst H. Effect of carotid endarterectomy on patterns of cerebrovascular reactivity in patients with unilateral carotid artery stenosis. Stroke 1994;25:1952–1957.
15.
Thiel A, Zickmann B, Stertmann WA, Wyderka T, Hempelmann G. Cerebrovascular carbon dioxide reactivity in carotid artery disease. Relation to intraoperative cerebral monitoring results in 100 carotid endarterectomies. Anesthesiology 1995;82:655–661.
16.
Hartl WH, Fürst H. Application of transcranial Doppler sonography to evaluate cerebral hemodynamics in carotid artery disease. Comparative analysis of different hemodynamic variables. Stroke 1995;26:2293–2297.
17.
Bishop CCR, Insall M, Powell S, Rutt D, Browse NL. Effect of internal carotid artery occlusion on middle cerebral artery blood flow at rest and in response to hypercapnia. Lancet 1986;1:710–712.
18.
Dahl A, Russell D, Nyberg-Hansen R, Rootwelt K, Bakke SJ. Cerebral vasoreactivity in unilateral carotid artery disease. Stroke 1994;25:621–626.
19.
Isaka Y, Okamoto M, Ashida K, Imaizumi M. Decreased cerebrovascular dilatory capacity in subjects with asymptomatic periventricular hyperintensities. Stroke 1994;25:375–381.
20.
Kuwabara Y, Ichiya Y, Sasaki M, et al. Cerebral blood flow and vascular response to hypercapnia in hypertensive patients with leukoaraiosis. Ann Nucl Med 1996;10:293–298.
21.
Hofman A, Grobbee DE, De Jong PTVM, Van den Ouweland FA. Determinants of disease and disability in the elderly : the Rotterdam Elderly Study. Eur J Epidemiol 1991;7:403–422.
22.
Dixon WJ. BMDP statistical software manual. Berkeley:University of California Press, 1990.
23.
Fazekas F. Magnetic resonance signal abnormalities in asymptomatic individuals : their incidence and functional correlates. Eur Neurol 1989;29:164–168.
24.
Kobayashi S, Okada K, Yamashita K. Incidence of silent lacunar lesion in normal adults and its relation to cerebral blood flow and risk factors. Stroke 1991;22:1379–1383.
25.
Meguro K, Hatazawa J, Yamaguchi T, et al. Cerebral circulation and oxygen metabolism associated with subclinical periventricular hyperintensity as shown by magnetic resonance imaging. Ann Neurol 1990;28:378–383.
26.
De Cristofaro MTR, Mascalchi M, Pupi A, et al. Subcortical arteriosclerotic encephalopathy : single photon emission computed tomography–magnetic resonance imaging correlation. Am J Physiol Imaging 1990;5:68–74.
27.
Kawamura J, Meyer JS, Terayama Y, Weathers S. Leuko-araiosis and cerebral hypoperfusion compared in elderly normals and Alzheimer’s dementia. J Am Geriatr Soc 1992;40:375–380.
28.
Rowbotham GF, Little E. Circulation of the cerebral hemispheres. Br J Surg 1965;52:8–21.
29.
Ravens JR. Anastomoses in the vascular bed of the human cerebrum. In: Cervós-Navarro J, ed. Pathology of cerebral microcirculation. Berlin:Walter de Gruyter, 1974:26–38.
30.
De Reuck J. The human periventricular arterial blood supply and the anatomy of cerebral infarctions. Eur Neurol 1971;5:321–334.
31.
Rosner SS, Rhoton AL Jr, Ono M, Barry M. Microsurgical anatomy of the anterior perforating arteries. J Neurosurg 1984;61:468–485.
32.
Meyer JS, Terayama Y, Takashima S. Cerebral circulation in the elderly. Cerebrovasc Brain Metab Rev 1993;5:122–146.
33.
Moody DM, Bell MA, Challa VR. Features of the cerebralvascular pattern that predict vulnerability to perfusion or oxygenation deficiency : an anatomic study. Am J Neuroradiol 1990;11:431–439.
34.
Nelson MD Jr, Gonzales-Gomez I, Gilles FH. The search for human telencephalic ventriculofugal arteries. Am J Neuroradiol 1991;12:215–222.
35.
Mayer PL, Kier EL. The controversy of the periventricular white matter circulation : a review of the anatomic literature. Am J Neuroradiol 1991;12:223–228.
36.
Van Swieten JC, Van den Hout JHW, Van Ketel BA, Hijdra A, Wokke JHJ, Van Gijn J. Periventricular lesions in the white matter on magnetic resonance imaging in the elderly. Brain 1991;114:761–774.
37.
Van Swieten JC, Geyskes GG, Derix MA, et al. Hypertension in the elderly is associated with white matter lesions and cognitive decline. Ann Neurol 1991;30:825–830.
38.
Bots ML, Breslau PJ, Briët E, et al. Cardiovascular determinants of carotid artery disease. The Rotterdam Elderly Study. Hypertension 1992;19:717–720.
39.
Bots ML, Van Swieten JC, Breteler MMB, et al. Cerebral white matter lesions and atherosclerosis in the Rotterdam Study. Lancet 1993;341:1232–1237.

Information & Authors

Information

Published In

Neurology®
Volume 52Number 3February 1, 1999
Pages: 578
PubMed: 10025791

Publication History

Received: August 5, 1998
Accepted: October 17, 1998
Published online: February 1, 1999
Published in print: February 1, 1999

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Authors

Affiliations & Disclosures

S.L. M. Bakker, MD
From the Department of Neurology (Drs. Bakker and Koudstaal)University Hospital Rotterdam, Department of Epidemiology & Biostatistics (Drs. Bakker, de Leeuw, de Groot, Hofman, and Breteler), Erasmus University Medical School, Rotterdam, the Netherlands.
F.-E. de Leeuw, MD
From the Department of Neurology (Drs. Bakker and Koudstaal)University Hospital Rotterdam, Department of Epidemiology & Biostatistics (Drs. Bakker, de Leeuw, de Groot, Hofman, and Breteler), Erasmus University Medical School, Rotterdam, the Netherlands.
J.C. de Groot, MD
From the Department of Neurology (Drs. Bakker and Koudstaal)University Hospital Rotterdam, Department of Epidemiology & Biostatistics (Drs. Bakker, de Leeuw, de Groot, Hofman, and Breteler), Erasmus University Medical School, Rotterdam, the Netherlands.
A. Hofman, MD, PhD
From the Department of Neurology (Drs. Bakker and Koudstaal)University Hospital Rotterdam, Department of Epidemiology & Biostatistics (Drs. Bakker, de Leeuw, de Groot, Hofman, and Breteler), Erasmus University Medical School, Rotterdam, the Netherlands.
P.J. Koudstaal, MD, PhD
From the Department of Neurology (Drs. Bakker and Koudstaal)University Hospital Rotterdam, Department of Epidemiology & Biostatistics (Drs. Bakker, de Leeuw, de Groot, Hofman, and Breteler), Erasmus University Medical School, Rotterdam, the Netherlands.
M.M. B. Breteler, MD, PhD
From the Department of Neurology (Drs. Bakker and Koudstaal)University Hospital Rotterdam, Department of Epidemiology & Biostatistics (Drs. Bakker, de Leeuw, de Groot, Hofman, and Breteler), Erasmus University Medical School, Rotterdam, the Netherlands.

Notes

Address correspondence and reprint requests to Dr. Stef L.M. Bakker, Department of Neurology, University Hospital Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.

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