Lindgren A, Roijer A, Rudling O, Norrving B, Larsson E M, Eskilsson J, Wallin L, Olsson B, Johansson B B
Department of Neurology, University Hospital, Lund, Sweden.
Stroke. 1994 May;25(5):929-34. doi: 10.1161/01.str.25.5.929.
To assess the prevalence of asymptomatic abnormalities on magnetic resonance imaging of the brain and their possible relation to hypertension, heart disease, and carotid artery disease, we studied 77 randomly selected subjects (mean age, 65.1 years; range, 36 to 95 years) with no history of focal brain lesions.
The study protocol included magnetic resonance imaging of the brain, transthoracic and transesophageal echocardiography, ultrasonography of the carotid arteries, and electrocardiographic recording. Deep and periventricular white matter hyperintensities on magnetic resonance imaging were assessed both separately and together.
On magnetic resonance imaging of the brain 62.3% (95% confidence interval [CI], 51.5% to 73.2%) of the subjects had white matter hyperintensities. These abnormalities increased significantly with age (chi 2 test; P = .0001), from 13.6% (95% CI, 0% to 28.0%) of subjects aged younger than 55 years to 85.2% (95% CI, 71.8% to 98.6%) of subjects aged 75 years or older. Six subjects had deep gray matter hyperintensities localized in the basal ganglia, and one had a cerebellar infarction. Stepwise logistic regression analysis identified age and a history of heart disease (but not echocardiographic findings) to be independently associated with deep and periventricular white matter hyperintensities. Hypertension was only independently associated with periventricular white matter hyperintensities. Of the 68 subjects examined with both transthoracic and transesophageal echocardiography, potential cardioembolic sources were detected in 38.2% (95% CI, 26.7% to 49.8%) of the subjects with transthoracic echocardiography and in 47.1% (95% CI, 35.2% to 58.9%) of those with transthoracic and transesophageal echocardiography combined. In subjects aged 75 years or older, a possible cardiac embolic source was detected in 64.0% on transthoracic echocardiography and in 72.0% on transthoracic and transesophageal echocardiography combined, compared with 5.3% and 15.8%, respectively, in subjects aged younger than 55 years.
White matter hyperintensities and potential cardioembolic sources are frequently present in asymptomatic individuals, stressing the need for age-matched control subjects in studies of patients with stroke or dementia.
为评估脑部磁共振成像中无症状异常的患病率及其与高血压、心脏病和颈动脉疾病的可能关系，我们对77名随机选取的无局灶性脑病变病史的受试者（平均年龄65.1岁；范围36至95岁）进行了研究。
研究方案包括脑部磁共振成像、经胸和经食管超声心动图检查、颈动脉超声检查以及心电图记录。分别对磁共振成像上的深部和脑室周围白质高信号进行评估，也将两者一起评估。
在脑部磁共振成像检查中，62.3%（95%置信区间[CI]，51.5%至73.2%）的受试者存在白质高信号。这些异常随年龄显著增加（卡方检验；P = 0.0001），从55岁以下受试者中的13.6%（95%CI，0%至28.0%）增至75岁及以上受试者中的85.2%（95%CI，71.8%至98.6%）。6名受试者在基底节区有深部灰质高信号，1名有小脑梗死。逐步逻辑回归分析确定年龄和心脏病史（而非超声心动图检查结果）与深部和脑室周围白质高信号独立相关。高血压仅与脑室周围白质高信号独立相关。在68名接受经胸和经食管超声心动图检查的受试者中，经胸超声心动图检查发现38.2%（95%CI，26.7%至49.8%）的受试者存在潜在的心源性栓塞源，经胸和经食管超声心动图联合检查发现47.1%（95%CI，35.2%至58.9%）的受试者存在潜在的心源性栓塞源。在75岁及以上的受试者中，经胸超声心动图检查发现64.0%的受试者存在可能的心源性栓塞源，经胸和经食管超声心动图联合检查发现72.0%的受试者存在可能的心源性栓塞源，相比之下，55岁以下受试者中的这一比例分别为5.3%和15.8%。
白质高信号和潜在的心源性栓塞源在无症状个体中经常出现，这凸显了在中风或痴呆患者研究中需要有年龄匹配对照受试者的必要性。
