242 Scientific Programme 22. European Stroke Conference © 2013 S. Karger AG, Basel 9 Small vessel stroke and white matter disease Quantitative Analysis of Leukoaraiosis Burden in 2363 Consecutive Acute Ischemic Stroke Pa-tients: A Report from the Korea’s Nationwide Image-based Stroke Database Project D.-E. Kim1, S.-H. Woo2, M.-U. Jang3, S.-W. Jeong4, J.-M. Park5, J.-K. Cha6, S.J. Lee7, B.-C. Lee8, K.-H. Yu9, K.-S. Cho10, K.-S. Hong11, K.-B. Lee12, K.-J. Park13, H.-K. Choi14, H.-J. Bae15 Department of Neurology, Dongguk University Ilsan Hospital, Goyang, SOUTH KOREA1, Department of Neurology, Dongguk University Ilsan Hospital, , 2, Department of Neurology, Seoul National University Bundang Hospital, , 3, Department of Neurology, Dongguk University Ilsan Hospital, , 4, Department of Neurology, Eulji General Hospital, Eulji University, , 5, Department of Neurology, Dong-A University College of Medicine, , 6, Department of Neurology, Eulji University Hospital, Eulji University, , 7, Department of Neurology, Hallym University Sacred Heart Hospital, , 8, Department of Neurology, Hallym University Sacred Heart Hospital, , 9, Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, , 10, Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, , 11, Department of Neurolo-gy, Soonchunhyang University Hospital, , 12, WeBace Co., Ltd., Busan, , 13, Departments of Comput-er Engineering, Inje University, , 14, Department of Neurology, Seoul National University Bundang Hospital 15 Background: We recently developed a new image-based acute stroke database and a custom-built software package (Image_QNA) to support it. Based on the system, Korean Brain MRI Data Center (with 11 academic hospitals) launched a nationwide image-based stroke database project. Objective: To report on the age-stratum-specific reference data for the extent of leukoaraiosis on fluid atten-uation inversion recovery (FLAIR) MRI in stroke patients. Methods: A total of 2363 consecutive patients (age 66.4+/-12.7 years; 1403 men and 960 women), who were admitted during 2011/5/15 ~ 2011/12/31 with acute (≤ 1 week) MRI-confirmed ischemic stroke, had their MR lesions pro-spectively segmented and registered on the ch2better-brain-template. The registered data included high-signal-intensity ischemic lesions on diffusion, T2-weighted, or FLAIR MRIs, and low-sig-nal- intensity hemorrhagic lesions on gradient-echo MRIs. Leukoaraiosis burden was calculated as the percentage of brain parenchymal volume. In addition, we prospectively collected demographic / laboratory data, medication history, and the presence of stroke risk factors. Results: The leukoara-iois burden (on topographic lesion maps) showed a quadratic increase with age (r2=0.98, p<0.01): median-leukoaraiosis-volume-% 0.11% (age 35~44 years, n=107), 0.22% (45~54, n=292), 0.32% (55~64, n=475), 0.68% (65~74, n=779), 0.83% (75~84, n=571), 1.12% (85~100, n=108). When 490 patients with a previous stroke history were excluded, leukoaraiosis burden again showed a qua-dratic increase with age (r2=0.99, p<0.01): 0.11% (35~44, n=101), 0.20% (45~54, n=245), 0.28% (55~64, n=392), 0.52% (65~74, n=595), 0.72% (75~84, n=429), 0.96% (85~100, n=82). Robust multiple regression analysis showed that age and hypertension were independently correlated with the extent of leukoaraiosis (r2=0.17, p<0.05). Conclusion: This is the first nationwide multi-center prospective study to present the reference data for leukoaraiosis burden in Korean stroke patients. 8 Small vessel stroke and white matter disease Ultrastructural changes in small vessels in young/middle aged patients with leukoaraiosis - new microangiopathies or non specific features ? D.D. DZIEWULSKA1 MEDICAL UNIVERSITY OF WARSAW, WARSAW, POLAND1 BACKGROUND Cerebral small vessel disease (CSVD) is a very heterogenous group of microan-giopathies resulting in leukoaraiosis, vascular dementia, and lacunar strokes. Although CSVD is usually observed in old patients with various systemic diseases it is also found in young patients without risk factors for vascular damage. Introduction of skin-muscle biopsy into CSVD diagnos-tics has allowed to detect several new diseases/syndromes like CADASIL, CARASIL, PADMAL, and others. But spectrum of cerebral microangiopathies may be much wider than hitherto known disorders. MATERIAL AND METHODS In 8 patients at the age of 8-47 yrs ultrastructural examination of microvessels in skin-muscle biopsy material was performed. All patients were suspected for CADA-SIL and showed diffused or focal hyperintense changes in the cerebral white matter in brain MRI. RESULTS Ultrastructural examination revealed various types of morphological abnormalities in microvessels. In three unrelated patients and in two cases from the same family changes resembled onkosis. The affected endothelial cells and pericytes showed swelling, clearing of the cytosol, dila-tation of the endoplasmic reticulum and numerous intracytoplasmic vesicular structures. In one pa-tient vessels with thickened wall and abundant extracellular matrix were seen. In other case, in basal lamina, polymorphic deposits of un unknown material different than GOMs in CADASIL were found. Also in one patient, collapsed vessels with numerous endothelial processes invaginating into the lumen, and dilated mitochondria in endothelial cell cytoplasm were visible. CONCLUSIONS 1.Skin-muscle biopsy is a useful diagnostic method allowing to discover generalized microangiopa-thy in patients with leukoaraiosis. 2.Although ultrastructural changes in microvessels are probably not specific, they are so character-istic that, in future, may help to distinguish from a heterogenous group of CSVD new sporadic or hereditary disorders.
Karger_ESC London_2013
To see the actual publication please follow the link above