From the Department of Neurology, APHP, Lariboisière Hospital, Paris, France (O.O., H.C., E.J.).
University Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, France (O.O., F.D.G., H.C., E.J.).
Stroke. 2018 Aug;49(8):1920-1923. doi: 10.1161/STROKEAHA.118.021342.
Background and Purpose- In cerebral small vessel diseases, small subcortical ischemic lesions (SSIL) on diffusion imaging are responsible for stroke manifestations but can also be occasionally observed in the absence of overt neurological symptoms. We aimed to determine, in a large cohort of young patients with CADASIL (Cerebral Autosomal-Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy), a severe monogenic condition leading to SSIL in young patients, the characteristics of SSIL and of surrounding cerebral tissue associated with the presence of stroke symptoms. Methods- Among a cohort of 323 genetically confirmed CADASIL patients who were systematically evaluated every 18 months clinically and with magnetic resonance imaging, we studied all visible SSIL and documented ischemic stroke events with available magnetic resonance imaging data. We used mixed-effect logistic regression models to determine whether the presence of stroke symptoms was associated with age, sex, the volume of SSIL, their location with respect to preexisting white matter hyperintensities and with the load of the different magnetic resonance imaging markers of small vessel disease. Results- We identified 73 SSIL (30 with stroke symptoms and 43 without) in 55 patients. In multivariable models, stroke symptoms were more frequent in male patients (estimate=1.94; SE=0.82; P=0.03) and less frequent when SSIL appeared in contact to preexisting white matter hyperintensities (estimate=-2.12; SE=0.83; P=0.01). Within pyramidal tracts, stroke symptoms were more frequent in patients with extensive white matter hyperintensities (estimate=3.8×10; SE=9.3×10; P<10). Conclusions- Altogether, our results suggest that when SSIL occur, the presence of stroke symptoms may depend on sex and alterations of the surrounding brain tissue rather than on the characteristics of the SSIL itself.
背景与目的-在脑小血管疾病中，弥散成像上的小皮质下缺血性病变（SSIL）是导致中风表现的原因，但在没有明显神经症状的情况下也偶尔可见。我们旨在确定在一大群患有 CADASIL（伴有皮质下梗死和白质脑病的常染色体显性脑动脉病）的年轻患者中，这种导致年轻患者出现 SSIL 的严重单基因疾病，其 SSIL 的特征以及与中风症状相关的周围脑组织的特征。方法-在一组 323 名经基因证实的 CADASIL 患者中，我们对他们进行了系统的临床评估和磁共振成像评估，每 18 个月一次，在有磁共振成像数据的情况下，我们研究了所有可见的 SSIL，并记录了缺血性中风事件。我们使用混合效应逻辑回归模型来确定是否存在中风症状与年龄、性别、SSIL 的体积、与预先存在的脑白质高信号区的位置以及小血管疾病的不同磁共振成像标志物的负荷有关。结果-我们在 55 名患者中发现了 73 个 SSIL（30 个有中风症状，43 个没有）。在多变量模型中，男性患者中风症状更为常见（估计值=1.94；SE=0.82；P=0.03），而当 SSIL 与预先存在的脑白质高信号区接触时则更为少见（估计值=-2.12；SE=0.83；P=0.01）。在锥体束内，当广泛存在脑白质高信号区时，患者中风症状更为常见（估计值=3.8×10；SE=9.3×10；P<10）。结论-总之，我们的结果表明，当 SSIL 出现时，中风症状的存在可能取决于性别和周围脑组织的改变，而不是 SSIL 本身的特征。
