Dementia and Neurocognitive Disorders (대한치매학회지)

Korean Dementia Association (대한치매학회)
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White Matter Lesions Predominantly Located in Deep White Matter Represent Embolic Etiology Rather Than Small Vessel Disease

  • Young Hee Jung (Department of Neurology, Myoungji Hospital, College of Medicine, Hanyang University) ;
  • Seongbeom Park (Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Na Kyung Lee (Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Hyun Jeong Han (Department of Neurology, Myoungji Hospital, College of Medicine, Hanyang University) ;
  • Hyemin Jang (Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Hee Jin Kim (Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Sang Won Seo (Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Duk Lyul Na (Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2022.10.13
  • Accepted : 2023.01.28
  • Published : 2023.01.31
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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 WMH-distribution with minimal periventricular WMH suggests embolic etiologies.

Keywords

Acknowledgement

We would like to thank all the patients for their participation in the project.

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