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Diffusion-weighted imaging of the brain in preterm infants with focal and diffuse white matter abnormality.

OBJECTIVE: The most common finding on magnetic resonance imaging (MRI) of the brain in preterm infants at term-equivalent age is diffuse excessive high signal intensity (DEHSI) in the white matter. It is unclear whether DEHSI represents a biological abnormality. This study used diffusion-weighted imaging (DWI) to compare apparent diffusion coefficient (ADC) values in DEHSI with infants with normal imaging and those with overt brain damage to determine whether DEHSI shows the diffusion characteristics of normal or abnormal tissue. METHODS: MRI, using conventional and diffusion-weighted imaging (DWI), was performed in 50 preterm infants at term-equivalent age using a 1.5 Tesla MR scanner. The infants were divided into 3 groups on the basis of their MRI results: 1) normal white matter, 2) DEHSI, or 3) overt white matter pathology. ADC values were measured in the frontal, central, and posterior white matter at the level of the centrum semiovale. ADC values in the 3 groups of preterm infants were compared using a 1-way analysis of variance with a Bonferroni test for multiple comparisons. RESULTS: ADC values were significantly higher in infants with DEHSI and infants with overt white matter pathology than in infants with normal white matter. There was no significant difference between ADC values in infants with DEHSI and those with overt white matter pathology. CONCLUSIONS: This study provides objective evidence that DEHSI represents diffuse white matter abnormality.

Body Water↗

Prolonged indomethacin exposure is associated with decreased white matter injury detected with magnetic resonance imaging in premature newborns at 24 to 28 weeks' gestation at birth.

OBJECTIVES: Newborns delivered before 28 weeks' gestation commonly have white matter lesions on MRI that are associated with adverse neurodevelopmental outcomes. Our objective was to determine the risk factors for MRI-detectable white matter injury in infants delivered before 28 weeks' gestation who were treated with prophylactic indomethacin. METHODS: This was a prospective cohort study conducted at the intensive care nursery at University of California San Francisco Children's Hospital. Patients included 57 premature newborns between 24 and 27 (+6 days) weeks' gestation at birth (October 1998 to October 2004). We identified perinatal and neonatal risk factors associated with moderate-severe "white matter injuries" (T1 signal abnormalities >2 mm or >3 areas of T1 abnormality) and moderate-severe "brain abnormality" (moderate-severe white matter injuries, any degree of ventriculomegaly, or severe intraventricular hemorrhage) on MRI. Infants were studied with MRI at 31.1 weeks' postmenstrual age (median). RESULTS: Moderate-severe white matter injuries were detected in 12 (21%) of 53 preterm newborns, and 20 (35%) of 57 had moderate-severe brain abnormality. Prolonged indomethacin exposure was the only risk factor independently associated with a lower risk of white matter injury or brain abnormality, even when adjusting for the presence of a hemodynamically significant PDA, gestational age at birth, prenatal betamethasone, systemic infection, and days of mechanical ventilation. CONCLUSIONS: In this observational study, a longer duration of indomethacin exposure was associated with less white matter injury in infants delivered before 28 weeks' gestation. A randomized trial of prolonged indomethacin treatment is needed to determine whether indomethacin can decrease white matter injury and neurodevelopmental abnormalities.

Brain↗

White matter buckling: CT sign of extraaxial intracranial mass.

The resolution of present day computed tomography (CT) scanners routinely permits discrimination of gray from white matter with delineation of a gray-white matter interface. Superficially situated extraaxial masses usually preserve the gray-white interface and tend to compress and/or buckle adjacent edematous white matter. This does not occur with superficially situated intraaxial lesions and is, therefore, essentially diagnostic of an extraaxial mass. It is postulated that this sign reflects the relative resistance of gray matter to edema in conjunction with the destruction of th gray-white interface by the infiltration of intraaxial lesions. White matter buckling is almost invariably associated with extracerebral fluid collections. White matter buckling is almost invariably associated with extracerebral fluid collections. It is less often discernible in association with meningioma. In a series of 100 consecutive proven meningioma cases, compression and/or buckling of centra white matter was demonstrated in 28, and in 28 (40%) of 70 superficially situated lesions. White matter buckling is diagnostically significant when it occurs. It has been especially helpful in the diagnosis of otherwise atypical superficial masses.

Adult↗

Relative contributions of perceived mattering to parents and friends in predicting adolescents' psychological well-being.

Perceived mattering is the psychological tendency to perceive the self as significant to specific other people. The central goal of this study was to examine whether adolescents' perceived mattering across social spheres (parents and friends) is addtive or compensatory in predicting adolescents' psychological well-being. Tests of the relative importance of adolescents' perceived mattering to parents and friends for psychological well-being were conducted using data from two convenience samples. Study 1 participants were, on the average, 17.5 yr. old and living in rural northwestern United States (N=128, 50% male, n=64; 50% female, n=64). Study 2 participants, on the average, were 16.9 yr. old, from a suburban western Canadian region (N=532, 51.4% male, n=273; 48.6% female, n=259). Hierarchical regression analysed with indicators of self-concept and behavioral misconduct as dependent variables used perceived mattering to parents and perceived mattering to friends and the interaction between these two variables as independent variables. Perceived mattering in both social spheres seemed the optimal condition for adolescents. Perceived mattering to friends "added" to perceived mattering to parents in explaining variance in assessments of psychological well-being in both studies.

Adolescent↗

Validation of a near-infrared probe for detection of thin intracranial white matter structures.

OBJECT: The authors have developed an intracranial near-infrared (NIR) probe that analyzes the scattering of light emitted from its tip to measure the optical properties of cerebral tissue. Despite its success in distinguishing graymatter from white matter in humans during stereotactic surgery, the limits of this instrument's resolution remain unclear. In this study, the authors determined the spatial resolution of this new probe by using a rodent model supplemented with phantom measurements and computer simulation. METHODS: A phantom consisting of Intralipid and gelatin was constructed to resemble a layer of white matter overlying a layer of gray matter. Near-infrared measurements were obtained as the probe was inserted through the gray-white matter transition. A computer simulation of NIR measurements through a gray-white matter transition was also performed using Monte Carlo techniques. The NIR probe was then used to study 19 tracks from the cortical surface through the corpus callosum in an in vivo rodent preparation. The animals were killed and histological sections through the tracks were obtained. Data from the phantom models and computer simulations showed that the NIR probe samples a volume of tissue extending 1 to 1.5 mm in front of the probe tip (this distance is termed the "lookthrough" distance). Measurements obtained from an NIR probe passing through a thin layer of white matter consisted of an initial segment of increasing values, a maximum (peak) value, and a trailing segment of decreasing values. The length of the initial segment is the lookthrough distance, the position of the peak indicates the location of the superficial white matter boundary, and the length of the trailing segment is the thickness of the layer. These considerations were confirmed in experiments with rodents. All tracks passed through the corpus callosum, which was demonstrated as a broad peak on each NIR graph. The position of the dorsal boundary of the corpus callosum and its width (based on histological measurements) correlated well with the peak of the NIR curve and its trailing segment, respectively. The initial segments correlated well with estimates of the lookthrough distance. Five of the tracks transected the smaller anterior commissure (diameter 0.2 mm), producing a narrow NIR peak at the correct depth. CONCLUSIONS: Data in this study confirm that the NIR probe can reliably detect and measure the thickness of layers of white matter as thin as 0.2 mm. Such resolution should be adequate to detect larger structures of interest encountered during stereotactic surgery in humans.

Animals↗

Characterization of white matter lesions in multiple sclerosis and traumatic brain injury as revealed by magnetization transfer contour plots.

BACKGROUND AND PURPOSE: Magnetization transfer imaging provides information about the structural integrity of macromolecular substances, such as myelin. Our objective was to use this imaging technique and contour plotting to characterize and to define the extent of white matter lesions in multiple sclerosis and traumatic brain injury. METHODS: Magnetization transfer imaging was performed of 30 multiple sclerosis plaques and 10 traumatic white matter lesions. Magnetization transfer ratios (MTRs) were calculated for the lesions, for the normal- or abnormal-appearing surrounding white matter, and for remote normal-appearing white matter. MTR contour plots were constructed about these lesions. RESULTS: The contour plot appearance of MS plaques differed from that of traumatic white matter lesions. There was a gradual increase in MTR values at points at increasing distances from the center of the MS plaques; this was true for those lesions with and without surrounding T2 signal abnormality (halos). In contrast, there was an abrupt transition in MTR values between traumatic lesions and normal-appearing surrounding white matter. Additionally, the size of the MTR abnormality exceeded the size of the T2 signal abnormality for the MS plaques. CONCLUSION: MTR contour plots permit characterization and border definition of white matter lesions. Analysis of the contour plots suggests that MS is a centrifugal process with the lowest MTR within the center of the lesion. In contrast, traumatic white matter injuries are discrete lesions with abrupt transitions between the abnormal lesion and normal brain.

Adult↗

Correlations of extractable heavy metals with organic matters in contaminated river sediments.

In southern Taiwan, almost all the main rivers have been contaminated by anthropogenic heavy metals and organic matters. The main pollution sources include agricultural, industrial, and domestic activities. River sediments potentially have large capacities to accumulate heavy metals and organic matters when the river water flows through it. The sediments sampled from high contaminated river (the Yenshui River) and moderately contaminated rivers (the Tsengwen, Chishui, Potzu, and Peikang Rivers) were used to realize correlations between each kind of aqua regia extractable heavy metals (Co, Cr, Cu, Zn, Ni, Pb, Mn, and Fe) and organic matters in vertical sediment cores. Organic matters and aqua regia extractable heavy metal concentrations, analyzed by strong acid-digested extraction, were determined in vertical profile segments from downstream sediments of the five rivers. Sum of six aqua regia extractable heavy metals (Co, Cr, Cu, Zn, Ni, and Pb) were below 3,000 mg/kg in sediments of the Yenshui River, and below 500 mg/kg in the other four rivers' sediments. Strongly positive correlations (r = 0.83-0.95) between each kind of aqua regia extractable heavy metals and organic matters (concentration range between 0.6 to 3.8%) were observed in sediments of the Yenshui River. The slopes of the linear regressive lines approximated the average metal complexation ratios with organic matters in the sediments. In sediments of the other four rivers, smaller positive correlation coefficients between aqua regia extractable heavy metals and organic matters (below 2.6%) were observed. The complexation ratios derived from the four moderately polluted river sediments were smaller than those derived from the highly contaminated river sediments, indicating that the importance of organic matters in the accumulation of heavy metals in river sediments.

Environmental Monitoring↗

Delayed encephalopathy of acute carbon monoxide intoxication: diffusivity of cerebral white matter lesions.

BACKGROUND AND PURPOSE: Carbon monoxide intoxication has delayed effects on the cerebral white matter characterized by bilateral, confluent lesions that reflect diffuse demyelination. To increase our understanding of this process, we assessed the diffusion characteristics of these lesions. METHODS: Five consecutive patients with delayed encephalopathy of CO intoxication were examined with diffusion MR imaging. Diffusion-weighted images (DWIs) were obtained 25-95 days after their exposure to CO and during a relapse of neuropsychiatric symptoms, which occurred after an initial recovery. Imaging was performed at 1.5 T by using a spin-echo echo-planar sequence with diffusion gradients of 0, 500, and 1000 s/mm(2). DWIs and apparent diffusion coefficient (ADC) maps were visually evaluated, and mean ADCs were calculated from the periventricular white matter and the centrum semiovale, where confluent hyperintensity was seen on T2-weighted images. Findings were compared with those of normal-looking white matter. RESULTS: In all five patients, both T2-weighted images and DWIs showed the white matter lesions as bilateral, diffuse, confluent areas of hyperintensity in the periventricular white matter and centrum semiovale. On ADC maps, these lesions were isointense, with focal areas of hypointensity (n = 4) or diffuse hypointensity (n = 1). Mean ADC values of the white matter lesions were significantly lower than those of normal-looking white matter, regardless of their isointensity or hypointensity on ADC maps (P <.05). CONCLUSION: Bilateral, confluent, white matter lesions in patients with delayed encephalopathy of CO intoxication show decreased diffusivity.

Aged↗

[Accumulation pattern of dry matter, nitrogen, phosphorus, potassium and silicon in rice genotypes and their relationships].

The accumulation of dry matter, nitrogen, phosphorus, potassium and silicon in 30 rice genotypes and their relationships under field condition were studied. The results showed that dry matter accumulated at ripening stage linearly increased with increase of nitrogen, phosphorus, potassium and silicon accumulation with highly significant correlation coefficients at both early and late season. At the same time balance of nitrogen, phosphorus, potassium and silicon accumulation was beneficial for dry matter accumulation, which linearly increased with increase of nutrient balance index and decreased with increase of nutrient deviation index. The nitrogen, phosphorus, potassium and silicon were accumulated at the rate of 3.76:1:4.55:7.10 at early season and 2.88:1:4.54:8.09 at late season. During growth period, dry matter accumulation was the highest at middle stage, then late stage and early stage. But nitrogen accumulation was the highest at early stage, then middle stage and late stage. The dry matter accumulated before heading was mainly distributed in stem and leaf sheath, with the highest ratio of stem and leaf sheath to total dry matter at heading stage. In contrast, nitrogen accumulated before heading was mainly distributed in leaf blade, and the ratio of nitrogen in leaf blade to total nitrogen was higher than that of dry matter at either growth stages. Dry matter, nitrogen, phosphorus accumulated at ripening stage were mainly distributed in panicle with rates of 58.01%, 66.42% and 70.06%, respectively. But potassium accumulated at ripening stage was mainly distributed in stem and leaf sheath with the rate of 62.08%. Silicon was largely distributed in stem and leaf sheath at early season with the rate of 43.11%, but distributed largely in panicle at late season with the rate of 46.99%.

Genotype↗

[Transformation of organic matter during thermophilic composting of pig manure].

Thermophilic composting of pig manure was studied in an attempt to elaborate upon organic matter transformation during the process and provided parameters for product maturity using chemical method. The following parameters were measured in 11 samples during the 42 days of composting: organic matter, dissolved organic carbon (DOC), degradable organic matter and humic matter (HM). Organic matter decreased during composting process constantly; DOC concentration increased to maximum at 10 days and declined thereafter; degradable organic matter decreased whole composting, but they increased in start of high-temperature stage; The increasing level of HM at various stages of composting indicate the progression of humification; H/F provide information correlating to conventional chemical parameters (organic matter, DOC) of compost maturity. Moreover, H/F has correlating to degradable organic matter and HM.

Animals↗

Changes in cerebral blood flow and oxygen metabolism related to magnetic resonance imaging white matter hyperintensities in Alzheimer's disease.

UNLABELLED: We studied changes in cerebral perfusion and oxygen metabolism to elucidate the pathophysiological nature and clinical significance of white matter hyperintensities in Alzheimer's disease (AD). METHODS: Sixteen AD patients (age 71.6 +/- 3.1 yr) whose T2-weighted MR images showed white matter hyperintensities, and 16 age-matched AD patients (age 71.0 +/- 4.3 yr) without white matter hyperintensities were compared. Regional cerebral blood flow (CBF), oxygen metabolism (CMRO2) and oxygen extraction fraction (OEF) were measured by using (15)O steady-state method and PET. RESULTS: There was no significant difference in cognitive impairment between the two groups. Compared to the patients without white matter hyperintensities, those with them had significantly low CBF values and significantly high OEF values in all cortical and white matter regions. However, there were no significant differences in CMRO2 values between the two groups. Severity of white matter hyperintensities correlated with the mean cortical and mean white matter OEF. CONCLUSION: In AD patients, white matter hyperintensities on T2-weighted MR images represent ischemic changes in which oxygen metabolism and function are fairly compensated. These changes are not disease-specific but are age-associated coincidences, as in normal aging with or without vascular risk factors.

Aged↗

Cerebral gray matter volume deficits in first episode psychosis.

BACKGROUND: Structural brain differences including decreased gray matter and increased cerebrospinal fluid volumes have been observed in the brains of chronically ill patients with schizophrenia. We hypothesized that deficits in gray matter volume would be present in patients presenting with a first episode of nonaffective psychosis. METHODS: We used magnetic resonance imaging to compare the brains of 77 patients assessed as having a first episode of psychosis (meeting DSM-III-R criteria for schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, or psychotic disorder not otherwise specified) with those of 61 healthy controls matched for age, sex, race, and parental socioeconomic status. Axial, dual-echo scans of the whole brain were segmented into gray matter, white matter, and cerebrospinal fluid compartments using a computerized volumetric approach. These measures were corrected for the significant effects of intracranial volume and age prior to performing between-group comparisons. RESULTS: The first episode psychosis group had significantly smaller gray matter volume (t[136] = -2.2; P = .03) and greater cerebrospinal fluid volume (t[136] = 2.5; P = .02) than normal controls. In the patient group, gray matter volumes were positively correlated with estimates of IQ but not with age of onset, duration of illness, or measures of premorbid functioning. CONCLUSIONS: Deficits in gray matter volume are present in patients experiencing first episode nonaffective psychosis. The magnitude of these differences is smaller than has been described in more chronically ill patients.

Adolescent↗

In vivo morphometry of the intrasulcal gray matter in the human cingulate, paracingulate, and superior-rostral sulci: hemispheric asymmetries, gender differences and probability maps.

Volumes of the intrasulcal gray matter were measured in three cerebral sulci located on the medial wall of the human frontal lobe: cingulate sulcus (CS), paracingulate sulcus (PCS), and superior-rostral sulcus (SRS). The measurements were carried out on T1-weighted 3-D high-resolution magnetic-resonance (MR) images acquired in 105 young right-handed volunteers (42 female and 63 male). Before the measurement, the images were transformed into a standardized stereotaxic space (Talairach and Tournoux [1988] Human Brain: 3-Dimensional Proportional System. An Approach to Cerebral Imaging. Stuttgart, New York: Georg Thieme Verlag), thus removing inter-individual differences in brain size. The intrasulcal gray matter was segmented in a semi-automatic manner. Significant gender differences were found in the volume of the CS (female > male) and the PCS (male > female). Hemispheric asymmetries were observed between the left and right volumes of the intrasulcal gray matter in the anterior (right > left) and posterior (left > right) segments of the CS, as well as between the left and right volumes of the PCS (left > right). There was no interaction between the asymmetries and gender. In addition, significant positive correlations were found between the left and right gray-matter volumes in the anterior (r = 0.43) and posterior (r = 0.66) segments of the CS, whereas significant negative correlations were observed between the gray-matter volumes of the anterior segment of the CS and those of the PCS (left hemisphere: r = -0.48; right hemisphere: r = -0.42). The observed hemispheric asymmetries in the CS and PCS gray-matter volumes are consistent with the proposed role of these structures in the integration of emotions with cognition (CS) and in the control of speech/vocalization (PCS). The pattern of inter-hemispheric correlations in the sulcal gray-matter points to an increasing asynchrony in the foetal development of primary (CS), secondary (SRS), and tertiary (PCS) sulci, respectively. The presence of negative correlations between the two neighbouring sulci (CS and PCS) suggests that a process of compensation could underlie interactions between adjacent primary and tertiary sulci. Besides the above volumetric analysis, we also provide average (probability) maps of the three sulci; the use of such maps for the parcellation of the medial frontal lobe and localization of "peaks" obtained in blood-flow activation studies is discussed.

Brain Mapping↗

Sorption of organic genotoxins to particulate matter in industrial effluents.

In an earlier work [White PA et al. (1996): Environ Mol Mutagen 27:116-139] we examined the genotoxicity of dichloromethane extracts from a variety of industrial effluent samples. in this companion work, we used the SOS Chromotest to investigate the sorption of the extracted genotoxins to effluent suspended particulate matter. The affinity of the genotoxins for particulate matter is expressed as a genotoxicity sorption partition coefficient (Kd-genotox). The results indicate that industries known for their emission of combustion by-products, such as polycyclic aromatic hydrocarbons, often have high Kd-genotox values (>/= 10(6). These include metal refining and founding industries as well metal surface treatment facilities. In contrast, Kd-genotox values for pulp and paper mills and sewage treatment facilities are several orders of magnitude lower (</= 10(4)). In several cases the calculated Kd-genotox values are in agreement with the Kow values of genotoxic substances isolated from genotoxic industrial waste samples studied by other researchers. The sorption partition coefficient, in conjunction with concentration of available particulate matter, was used to determine the percent of organic genotoxins adsorbed to effluent suspended particulate matter. Values range from 2.3% to 99.8%. High values (>70%) were obtained for metal surface treatment and inorganic and organic chemical production facilities. Low values (>30%) were obtained for sewage treatment facilities and pulp and paper mills. The results also demonstrate the effect of variations in the concentration of available particulate matter on the genotoxicity of both aqueous and particulate extracts. The results suggest that the sorptive properties of the particulate matter itself are reduced when the concentration of particulate matter is very high (>1,000 mg per 1). The use of sorption partition information in inferring the physical-chemical nature of the putative genotoxins and the implications of the results for assessing the hazard posed to aquatic biota by industrial genotoxins are discussed.

Adsorption↗

In vivo spectroscopic quantification of the N-acetyl moiety, creatine, and choline from large volumes of brain gray and white matter: effects of normal aging.

Volumetric proton magnetic resonance spectroscopic imaging (MRSI) was used to generate brain metabolite maps in 15 young and 19 elderly adult volunteers. All subjects also had structural MR scans, and a model, which took into account the underlying structural composition of the brain contributing to each metabolite voxel, was developed and used to estimate the concentration of the N-acetyl-moiety (NAc), creatine (Cr), and choline (Cho) in gray matter and white matter. NAc concentration (signal intensity per unit volume of brain) was higher in gray than white matter and did not differ between young and old subjects despite significant gray matter volume deficits in the older subjects. To the extent that NAc is an index of neuronal integrity, the available gray matter appears to be intact in these older healthy adults. Cr concentrations were much higher in gray than white matter and significantly higher in the old than young subjects. Cho concentration in gray matter was also significantly higher in old than young subjects. Independent determination of metabolite values rather than use of ratios is essential for characterizing age-related changes in brain MRS metabolites.

Adult↗

Homocysteine, silent brain infarcts, and white matter lesions: The Rotterdam Scan Study.

Silent brain infarcts and white matter lesions are frequently seen on magnetic resonance imaging in healthy elderly people and both are associated with an increased risk of stroke and dementia. Plasma total homocysteine may be a potentially modifiable risk factor for stroke and dementia. We examined whether elevated total homocysteine levels are associated with silent brain infarcts and white matter lesions. The Rotterdam Scan Study is a population-based study of 1,077 people aged 60 to 90 years who had cerebral magnetic resonance imaging. The cross-sectional relation of total homocysteine with silent infarcts and white matter lesions was analyzed with adjustment for cardiovascular risk factors. The mean plasma total homocysteine level was 11.5 micromol/l (standard deviation 4.1). The risk of silent brain infarcts increased with increasing total homocysteine levels (odds ratio 1.24/standard deviation increase, 95% confidence interval 1.06-1.45). The severity of periventricular white matter lesions and extent of subcortical white matter lesions were also significantly associated with total homocysteine levels, even after excluding those with silent brain infarcts. The overall risk of having either a silent brain infarct or severe white matter lesions was strongly associated with total homocysteine levels (odds ratio 1.35/standard deviation increase, 95% confidence interval 1.16-1.58). We concluded that total homocysteine levels are associated with silent brain infarcts and white matter lesions independent of each other and of other cardiovascular risk factors.

Aged↗

Detecting white matter injury in sickle cell disease using voxel-based morphometry.

OBJECTIVE: Sickle cell disease (SCD) is associated with cerebrovascular disease, cerebral infarction, and cognitive dysfunction. This study aimed to detect the presence and extent of white matter abnormalities in individuals with SCD using voxel-based morphometry (VBM). METHODS: Thirty-six children and adolescents with SCD (age range, 9-24 years) and 31 controls (8-25 years) underwent magnetic resonance investigations using T1- and T2-weighted protocols. White and gray matter density maps were obtained from three-dimensional magnetic resonance imaging (MRI) data sets. Using VBM, we compared the maps between controls and SCD individuals with silent white matter infarct lesions (SCD+L; n = 16), and those without visible abnormality (SCD-L; n = 20). RESULTS: In comparison with controls, intelligence quotients (IQs) were lower in both SCD groups irrespective of presence of visible lesions. VBM showed widespread bilateral white matter abnormalities in the SCD+L group, extending beyond the regions of focal infarction in the deep anterior and posterior white matter borderzones. Bilateral white matter abnormalities were also observed in the SCD-L group, in locations similar to those in the SCD+L group. INTERPRETATION: VBM is sensitive to detection of widespread white matter injury in SCD patients in borderzones between arterial territories even in the absence of evidence of infarction. Those changes may contribute to cognitive deficits in this population.

Adolescent↗

Hypodensity of the cerebral white matter in patients with transient ischemic attack or minor stroke: influence on the rate of subsequent stroke. Dutch TIA Trial Study Group.

In a prospective study of 3,017 patients with transient ischemic attack or minor ischemic stroke from the Dutch Transient Ischemic Attack Trial, the presence or absence of diffuse hypodensity of the white matter on a baseline computed tomography (CT) scan of the brain was related to the occurrence of subsequent stroke. On entry, 337 patients were judged to have diffuse hypodensity of the white matter on CT; they were older (71.4 +/- 7.4 years versus 64.4 +/- 9.9 years), more often had hypertension (50% versus 41%), and more often had lacunar infarcts on CT scan (40% versus 26%) than did patients with normal white matter. Strokes, fatal or nonfatal, occurred in 51 (15%) of the patients with diffuse hypodensity of the cerebral white matter, compared to 217 (8%) in the group with normal white matter (crude hazard ratio, 2.0; 95% confidence interval, 1.4-2.7). After adjustment for age and other relevant entry variables, the hazard ratio was 1.6 (95% confidence interval, 1.2-2.2). In patients younger than 70 years the crude hazard ratio was 2.7 (95% confidence interval, 1.7-4.2). The distribution between the main subtypes of stroke was similar for patients with and those without diffuse hypodensity of the cerebral white matter: Intracerebral hemorrhage occurred in 6 and 9%, cortical infarction in 47 and 45%, and lacunar infarction in 34 and 29%, respectively. We conclude that hypodensity of the cerebral white matter in patients with transient ischemic attack or minor stroke is associated with an extra risk of future stroke, from large as well as from small vessels, and particularly in patients under 70 years old; this increase of risk is independent of other risk factors for stroke.

Aged↗