Department of Neurology, Charite - University Medicine Berlin Germany.
Front Neurol. 2011 Sep 22;2:61. doi: 10.3389/fneur.2011.00061. eCollection 2011.
Microangiopathic brain lesions can be separated in diffuse lesions - leukoaraiosis - and focal lesions - lacunes. Leukoaraiosis and lacunes are caused by common cerebrovascular risk factors, but whether they represent a common entity is not sufficiently investigated. The present study aimed to determine the clinical profiles associated with the extent of leukoaraiosis and lacunes.
Sixty-four consecutive patients with acute microangiopathic stroke were studied. Leukoaraiosis and lacunes were stratified according to their MRI-based extent. Standardized clinical assessment included clinical syndromes, cerebrovascular risk factors, cognitive performance, retinal imaging, ultrasonography, blood, and urine parameters.
Different clinical profiles for leukoaraiosis and lacunes were found. Regarding leukoaraiosis, the cognitive scores (SISCO, mini mental score examination, mental examination) and the presence of hyperlipidemia decreased as the severity of leukoaraiosis increased. Univariate and multivariate analysis revealed that these cognitive score values as well as the presence of hyperlipidemia correlated significantly with no or only mild leukoaraiosis. Regarding lacunes, the percentage of migraine, previous stroke events, hydrocephalus, left ventricular hypertrophy, and a higher National Institutes of Health Stroke Scale increased as the number of lacunar lesions increased. Statistical analysis revealed that these parameters correlated not significantly with the number of lacunes.
The findings suggests that leukoaraiosis and lacunes are different microangiopathic entities potentially requiering different treatment concepts.
脑微出血病变可分为弥漫性病变-脑白质疏松症和局灶性病变-腔隙性梗死。脑白质疏松症和腔隙性梗死均由常见的脑血管危险因素引起，但它们是否代表同一疾病实体尚未得到充分研究。本研究旨在确定与脑白质疏松症和腔隙性梗死程度相关的临床特征。
连续纳入 64 例急性脑微出血患者。根据 MRI 显示的脑白质疏松症和腔隙性梗死程度进行分层。标准化临床评估包括临床综合征、脑血管危险因素、认知功能、视网膜成像、超声、血液和尿液参数。
发现脑白质疏松症和腔隙性梗死存在不同的临床特征。脑白质疏松症方面，认知评分（SISCO、简易精神状态检查、精神检查）和高血脂的存在随着脑白质疏松症严重程度的增加而降低。单因素和多因素分析显示，这些认知评分值以及高血脂的存在与无或仅有轻度脑白质疏松症显著相关。腔隙性梗死方面，偏头痛、既往卒中事件、脑积水、左心室肥厚以及美国国立卫生研究院卒中量表评分较高的患者腔隙性梗死灶数量增加。统计分析显示，这些参数与腔隙性梗死灶数量无显著相关性。
研究结果表明脑白质疏松症和腔隙性梗死是不同的脑微出血实体，可能需要不同的治疗概念。
