Author(s)

F. N. Doubal, A. M. J. MacLullich, K. J. Ferguson, M. S. Dennis, J. M. Wardlaw

ISBN

0039-2499

Publication year

2010

Periodical

Stroke

Periodical Number

3

Volume

41

Pages

450-454

Author Address

Doubal, FN Western Gen Hosp, Div Clin Neurosci, Bramwell Dott Bldg,Crewe Rd, Edinburgh EH4 2XU, Midlothian, Scotland Western Gen Hosp, Div Clin Neurosci, Edinburgh EH4 2XU, Midlothian, Scotland Univ Edinburgh, Ctr Cognit Ageing & Cognit Epidemiol, Edinburgh, Midlothian, Scotland

Full version

Background and Purpose-Enlarged perivascular spaces in the brain are common but generally overlooked and of uncertain pathophysiology. They may reflect underlying cerebral small vessel disease. We determined whether enlarged perivascular spaces were associated with lacunar stroke subtype and white matter hyperintensities, markers of established small vessel disease.
Materials and Methods-We prospectively recruited patients with acute ischemic lacunar or cortical stroke. Age-matched nonstroke control subjects were also recruited. We rated basal ganglia and centrum semiovale enlarged perivascular spaces 0 to 4 (0 = none, 4 = >40) on T2-weighted MRI and white matter hyperintensities. We compared enlarged perivascular spaces between stroke subtypes and control subjects and assessed associations with vascular risk factors and white matter hyperintensities.
Results-We recruited 350 patients; 129 lacunar, 124 cortical stroke, and 97 age-matched control subjects. Adjusting for vascular risk factors and white matter hyperintensities, total enlarged perivascular spaces were associated with lacunar stroke subtype (P = 0.04) in the acute stroke group (n = 253); basal ganglia enlarged perivascular spaces were associated with lacunar stroke subtype (P = 0.003), deep (P = 0.02) and periventricular white matter hyperintensities (P = 0.01); in all 350 subjects, total enlarged perivascular spaces were associated with deep (P < 0.001) and periventricular (P < 0.001) white matter hyperintensities. Conclusions-Although prevalent in patients with vascular risk factors and stroke, enlarged perivascular spaces are specifically associated with lacunar ischemic stroke and white matter hyperintensities. Further studies should determine the mechanism of this association while including adequate controls to account for stroke and vascular risk factors. Enlarged perivascular spaces should not be overlooked in studies of small vessel disease. (Stroke. 2010;41:450-454.)