Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-27T12:57:54.044Z Has data issue: false hasContentIssue false
  • English
  • Français

An observational study of T2-weighted white matter hyperintensities on magnetic resonance imaging of the internal auditory meatus and brain: ignore or not?

Published online by Cambridge University Press:  24 September 2021

X Huang ,
N Grimmond  and
G Kontorinis
X Huang*
Affiliation:
Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
N Grimmond
Affiliation:
ENT Department, University Hospital Crosshouse, Kilmarnock, Scotland, UK ENT Department, Queen Elizabeth University Hospital, Glasgow, UK
G Kontorinis
Affiliation:
ENT Department, Queen Elizabeth University Hospital, Glasgow, UK
*
Author for correspondence: Mr Xuya Huang, Institute of Neurological Sciences, Queen Elizabeth University Hospital, 1345 Govan Road, GlasgowG51 4TF, Scotland, UK E-mail: xuya.huang@nhs.net
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Magnetic resonance imaging of the internal auditory meatus frequently detects incidental white matter hyperintensities. This study investigated the association between these and the risk of stroke and transient ischaemic attack, or myocardial infarction.

Methods

The records of patients with incidental white matter hyperintensities were reviewed, and data were collected on: age, sex, cardiovascular risk factors, and incidence of stroke and transient ischaemic attack, or myocardial infarction, five years later. The risk factors associated with vascular events were explored.

Results

Of 6978 patients, 309 (4.4 per cent) had incidental white matter hyperintensities. Of these, 20 (6.5 per cent) had a stroke or transient ischaemic attack within five years, and 5 (1.7 per cent) had a myocardial infarction. The number of cardiovascular risk factors was significantly associated with the incidence of stroke and transient ischaemic attack (p = 0.004), and myocardial infarction (p = 0.023).

Conclusion

The number of cardiovascular risk factors predicts the likelihood of vascular events; appropriate risk factor management is recommended for patients with incidental white matter hyperintensities of presumed vascular origin.

Keywords

Cerebral White MatterMagnetic Resonance ImagingCerebral Small Vessel Diseases
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 135 , Issue 11 , November 2021 , pp. 964 - 969
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Mr X Huang takes responsibility for the integrity of the content of the paper

References

Morris, Z, Whiteley, WN, Longstreth, WT, Weber, F, Lee, Y-C, Tsushima, Y et al. Incidental findings on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ 2009;339:b3016CrossRefGoogle ScholarPubMed
Håberg, AK, Hammer, TA, Kvistad, KA, Rydland, J, Müller, TB, Eikenes, L et al. Incidental intracranial findings and their clinical impact; the HUNT MRI study in a general population of 1006 participants between 50–66 years. PLoS One 2016;11:e0151080CrossRefGoogle Scholar
Amiraraghi, N, Lim, S, Locke, R, Crowther, JA, Kontorinis, G. Findings on 7000 MRI of the IAM: to scan or not to scan?: A retrospective cohort study. Clin Otolaryngol 2018;43:1607–10CrossRefGoogle ScholarPubMed
Ylikoski, A, Erkinjuntti, T, Raininko, R, Sarna, S, Sulkava, R, Tilvis, R. White matter hyperintensities on MRI in the neurologically nondiseased elderly. Analysis of cohorts of consecutive subjects aged 55 to 85 years living at home. Stroke 1995;26:1171–7CrossRefGoogle ScholarPubMed
Garde, E, Mortensen, EL, Krabbe, K, Rostrup, E, Larsson, HB. Relation between age-related decline in intelligence and cerebral white-matter hyperintensities in healthy octogenarians: a longitudinal study. Lancet 2000;356:628–34CrossRefGoogle ScholarPubMed
Berry, C, Sidik, N, Pereira, AC, Ford, TJ, Touyz, RM, Kaski, JC et al. Small-vessel disease in the heart and brain: current knowledge, unmet therapeutic need, and future directions. J Am Heart Assoc 2019;8:e011104CrossRefGoogle ScholarPubMed
Grueter, BE, Schulz, UG. Age-related cerebral white matter disease (leukoaraiosis): a review. Postgrad Med J 2012;88:79–87CrossRefGoogle ScholarPubMed
Sachdev, PS, Thalamuthu, A, Mather, KA, Ames, D, Wright, MJ, Wen, W. White matter hyperintensities are under strong genetic influence. Stroke 2016;47:1422–8CrossRefGoogle ScholarPubMed
Debette, S, Markus, HS. The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ 2010;341:c3666CrossRefGoogle ScholarPubMed
Gouw, AA, Seewann, A, van der Flier, WM, Barkhof, F, Rozemuller, AM, Scheltens, P et al. Heterogeneity of small vessel disease: a systematic review of MRI and histopathology correlations. J Neurol Neurosurg Psychiatry 2011;82:126–35CrossRefGoogle ScholarPubMed
Fazekas, F, Kleinert, R, Offenbacher, H, Schmidt, R, Kleinert, G, Payer, F et al. Pathologic correlates of incidental MRI white matter signal hyperintensities. Neurology 1993;43:1683–9CrossRefGoogle ScholarPubMed
Fernando, MS, Simpson, JE, Matthews, F, Brayne, C, Lewis, CE, Barber, R et al. White matter lesions in an unselected cohort of the elderly: molecular pathology suggests origin from chronic hypoperfusion injury. Stroke 2006;37:1391–8CrossRefGoogle Scholar
Pantoni, L, Garcia, JH. Pathogenesis of leukoaraiosis: a review. Stroke 1997;28:652–9CrossRefGoogle ScholarPubMed
Pantoni, L, Garcia, JH. The significance of cerebral white matter abnormalities 100 years after Binswanger's report. A review. Stroke 1995;26:1293–301CrossRefGoogle ScholarPubMed
Staszewski, J, Piusinska-Macoch, R, Brodacki, B, Skrobowska, E, Macek, K, Stepien, A. Risk of vascular events in different manifestations of cerebral small vessel disease: a 2-year follow-up study with a control group. Heliyon 2017;3:e00455CrossRefGoogle ScholarPubMed
Rensma, SP, van Sloten, TT, Launer, LJ, Stehouwer, CDA. Cerebral small vessel disease and risk of incident stroke, dementia and depression, and all-cause mortality: a systematic review and meta-analysis. Neurosci Biobehav Rev 2018;90:164–73CrossRefGoogle ScholarPubMed
Poels, MM, Steyerberg, EW, Wieberdink, RG, Hofman, A, Koudstaal, PJ, Ikram, MA et al. Assessment of cerebral small vessel disease predicts individual stroke risk. J Neurol Neurosurg Psychiatry 2012;83:1174–9CrossRefGoogle ScholarPubMed
Staals, J, Makin, SD, Doubal, FN, Dennis, MS, Wardlaw, JM. Stroke subtype, vascular risk factors, and total MRI brain small-vessel disease burden. Neurology 2014;83:1228–34CrossRefGoogle ScholarPubMed
Pinter, D, Ritchie, SJ, Doubal, F, Gattringer, T, Morris, Z, Bastin, ME et al. Impact of small vessel disease in the brain on gait and balance. Sci Rep 2017;7:41637CrossRefGoogle ScholarPubMed
Kelly-Hayes, M. Influence of age and health behaviors on stroke risk: lessons from longitudinal studies. J Am Geriatr Soc 2010;58(suppl 2):S325–8CrossRefGoogle ScholarPubMed
Haller, S, Kövari, E, Herrmann, FR, Cuvinciuc, V, Tomm, AM, Zulian, GB et al. Do brain T2/FLAIR white matter hyperintensities correspond to myelin loss in normal aging? A radiologic-neuropathologic correlation study. Acta Neuropathol Commun 2013;1:14CrossRefGoogle ScholarPubMed
Schmidt, R, Petrovic, K, Ropele, S, Enzinger, C, Fazekas, F. Progression of leukoaraiosis and cognition. Stroke 2007;38:2619–25CrossRefGoogle ScholarPubMed
Gelbenegger, G, Postula, M, Pecen, L, Halvorsen, S, Lesiak, M, Schoergenhofer, C et al. Aspirin for primary prevention of cardiovascular disease: a meta-analysis with a particular focus on subgroups. BMC Med 2019;17:198CrossRefGoogle ScholarPubMed
Judge, C, Ruttledge, S, Murphy, R, Loughlin, E, Gorey, S, Costello, M et al. Aspirin for primary prevention of stroke in individuals without cardiovascular disease – a meta-analysis. Int J Stroke 2020;15:9–17CrossRefGoogle ScholarPubMed
van Zagten, M, Boiten, J, Kessels, F, Lodder, J. Significant progression of white matter lesions and small deep (lacunar) infarcts in patients with stroke. Arch Neurol 1996;53:650–5CrossRefGoogle ScholarPubMed
Sachdev, P, Wen, W, Chen, X, Brodaty, H. Progression of white matter hyperintensities in elderly individuals over 3 years. Neurology 2007;68:214–22CrossRefGoogle ScholarPubMed
Gouw, AA, van der Flier, WM, Fazekas, F, van Straaten, EC, Pantoni, L, Poggesi, A et al. Progression of white matter hyperintensities and incidence of new lacunes over a 3-year period: the Leukoaraiosis and Disability Study. Stroke 2008;39:1414–20CrossRefGoogle Scholar