Dement Neurocogn Disord.
2023 Jan;22(1):28-42. 10.12779/dnd.2023.22.1.28.
White Matter Lesions Predominantly Located in Deep White Matter Represent Embolic Etiology Rather Than Small Vessel Disease
- Affiliations
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- 1Department of Neurology, Myoungji Hospital, College of Medicine, Hanyang University, Goyang, Korea
- 2Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- 3Stem Cell & Regenerative Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
- 4Alzheimer’s Disease Convergence Research Center, Samsung Medical Center, Seoul, Korea
- 5Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea
- 6Department of Health Science and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
- 7Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Korea
- KMID: 2545083
- DOI: http://doi.org/10.12779/dnd.2023.22.1.28
Abstract
- Background and Purpose
We investigated the correlation between the deep distribution of white matter hyperintensity (WMH) (dWMH: WMH in deep and corticomedullary areas, with minimal periventricular WMH) and a positive agitated saline contrast echocardiography result.
Methods
We retrospectively recruited participants with comprehensive dementia evaluations, an agitated saline study, and brain imaging. The participants were classified into two groups according to WMH-distributions: dWMH and dpWMH (mainly periventricular WMH with or without deep WMH.) We hypothesized that dWMH is more likely associated with embolism, whereas dpWMH is associated with small-vessel diseases. We compared the clinical characteristics, WMH-distributions, and positive rate of agitated saline studies between the two groups.
Results
Among 90 participants, 27 and 12 met the dWMH and dpWMH criteria, respectively. The dWMH-group was younger (62.2±7.5 vs. 78.9±7.3, p<0.001) and had a lower prevalence of hypertension (29.6% vs. 75%, p=0.008), diabetes mellitus (3.7% vs. 25%, p=0.043), and hyperlipidemia (33.3% vs. 83.3%, p=0.043) than the dpWMH-group. Regarding deep white matter lesions, the number of small lesions (<3 mm) was higher in the dWMH-group(10.9±9.7) than in the dpWMH-group (3.1±6.4) (p=0.008), and WMH was predominantly distributed in the border-zones and corticomedullary areas. Most importantly, the positive agitated saline study rate was higher in the dWMH-group than in the dpWMH-group (81.5% vs. 33.3%, p=0.003).
Conclusions
The dWMH-group with younger participants had fewer cardiovascular risk factors, showed more border-zone-distributions, and had a higher agitated saline test positivity rate than the dpWMH-group, indicating that corticomedullary or deep WMHdistribution with minimal periventricular WMH suggests embolic etiologies.
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