Appropriate diagnosis and treatment for lacunar infarcts and leukoaraiosis without stroke symptoms_West China Medical Journal

Authors：

XU Mangmang ,  LIU Ming

Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

LIU Ming, Email: wyplmh@hotmail.com

Keywords：

Ischemic lesions; lacunar infarcts; leukoaraiosis; cerebral small vessel disease

DOI：

10.7507/1002-0179.202205018

Video：

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Abstract Full text Figures/Tables Video References Cited by

Ischemic lesions, lacunar infarcts and leukoaraiosis on head CT or MRI are commonly detected in patients with non-specific symptoms such as dizziness and headache or people undergoing healthy physical examinations. Although these imaging findings are mostly related to vascular disease, especially cerebral small vessel disease, it does not mean that long-term use of antiplatelet drugs and statins are required. On the basis of literature review and clinical experiences, the article points out that the treatment methods for such manifestations include determining whether these lesions are vascular lesions, searching for risk factors or causes such as aging, hypertension, diabetes mellitus, vascular stenosis, and psychological factors, and taking strategies for the corresponding prevention and management, provides a reference for the appropriate diagnosis and treatment of these imaging manifestations in clinical practice.

Citation： XU Mangmang, LIU Ming. Appropriate diagnosis and treatment for lacunar infarcts and leukoaraiosis without stroke symptoms. West China Medical Journal, 2022, 37(6): 801-805. doi: 10.7507/1002-0179.202205018 Copy

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2.	徐芒芒, 姜帥, 陶文丹, 等. 認識急性腦小血管病與非急性腦小血管病及其影像標志物的區別及聯系. 華西醫學, 2021, 36(6): 725-730.
3.	Wardlaw JM, Debette S, Jokinen H, et al. ESO guideline on covert cerebral small vessel disease. Eur Stroke J, 2021, 6(2): CⅪ-CLⅫ.
4.	Smith EE, Saposnik G, Biessels GJ, et al. Prevention of stroke in patients with silent cerebrovascular disease: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2017, 48(2): e44-e71.
5.	Fanning JP, Wesley AJ, Wong AA, et al. Emerging spectra of silent brain infarction. Stroke, 2014, 45(11): 3461-3471.
6.	中華醫學會神經病學分會, 中華醫學會神經病學分會腦血管病學組. 中國無癥狀腦梗死診治共識. 中華神經科雜志, 2018, 51(9): 692-698.
7.	Vermeer SE, Koudstaal PJ, Oudkerk M, et al. Prevalence and risk factors of silent brain infarcts in the population-based Rotterdam Scan Study. Stroke, 2002, 33(1): 21-25.
8.	Fanning JP, Wong AA, Fraser JF. The epidemiology of silent brain infarction: a systematic review of population-based cohorts. BMC Med, 2014, 12: 119.
9.	Hao Z, Chen Y, Wright N, et al. Natural history of silent lacunar infarction: 10-year follow-up of a community-based prospective study of 0.5 million Chinese adults. Lancet Reg Health West Pac, 2021, 17: 100309.
10.	Prins ND, Scheltens P. White matter hyperintensities, cognitive impairment and dementia: an update. Nat Rev Neurol, 2015, 11(3): 157-165.
11.	Xu M, Li B, Zhong D, et al. Cerebral small vessel disease load predicts functional outcome and stroke recurrence after intracerebral hemorrhage: a median follow-up of 5 years. Front Aging Neurosci, 2021, 13: 628271.
12.	Hopkins RO, Beck CJ, Burnett DL, et al. Prevalence of white matter hyperintensities in a young healthy population. J Neuroimaging, 2006, 16(3): 243-251.
13.	de Groot JC, de Leeuw FE, Oudkerk M, et al. Cerebral white matter lesions and depressive symptoms in elderly adults. Arch Gen Psychiatry, 2000, 57(11): 1071-1076.
14.	Steffens DC, Krishnan KR, Crump C, et al. Cerebrovascular disease and evolution of depressive symptoms in the cardiovascular health study. Stroke, 2002, 33(6): 1636-1644.
15.	Roelofs EF, Bas-Hoogendam JM, van der Werff SJA, et al. Exploring the course of adolescent anxiety and depression: associations with white matter tract microstructure. Eur Arch Psychiatry Clin Neurosci, 2021: 8.
16.	Greenberg T, Bertocci MA, Versace A, et al. Depression and anxiety mediate the relationship between frontotemporal white matter integrity and quality of life in distressed young adults. J Psychiatr Res, 2021, 132: 55-59.
17.	吳波, 劉鳴. 重視急性腦小血管病的診治與研究. 中華神經科雜志, 2021, 54(10): 983-993.
18.	Gouw AA, Seewann A, van der Flier WM, et al. Heterogeneity of small vessel disease: a systematic review of MRI and histopathology correlations. J Neurol Neurosurg Psychiatry, 2011, 82(2): 126-135.
19.	Wardlaw JM, Smith C, Dichgans M. Small vessel disease: mechanisms and clinical implications. Lancet Neurol, 2019, 18(7): 684-696.
20.	Kent DM, Leung LY, Zhou Y, et al. Association of silent cerebrovascular disease identified using natural language processing and future ischemic stroke. Neurology, 2021, 97(13): e1313-e1321.
21.	Debette S, Markus HS. The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ, 2010, 341: c3666.
22.	中華醫學會神經病學分會, 中華醫學會神經病學分會腦血管病學組. 中國腦血管病一級預防指南 2019. 中華神經科雜志, 2019, 52(9): 684-709.
23.	White WB, Wakefield DB, Moscufo N, et al. Effects of intensive versus standard ambulatory blood pressure control on cerebrovascular outcomes in older people (INFINITY). Circulation, 2019, 140(20): 1626-1635.
24.	C?té R, Battista RN, Abrahamowicz M, et al. Lack of effect of aspirin in asymptomatic patients with carotid bruits and substantial carotid narrowing. The Asymptomatic Cervical Bruit Study Group. Ann Intern Med, 1995, 123(9): 649-655.
25.	King A, Shipley M, Markus H, et al. The effect of medical treatments on stroke risk in asymptomatic carotid stenosis. Stroke, 2013, 44(2): 542-546.
26.	Han HJ, Kim BC, Youn YC, et al. A Comparison study of cilostazol and aspirin on changes in volume of cerebral small vessel disease white matter changes: protocol of a multicenter, randomized controlled trial. Dement Neurocogn Disord, 2019, 18(4): 138-148.
27.	Mok VC, Lam WW, Fan YH, et al. Effects of statins on the progression of cerebral white matter lesion: post hoc analysis of the ROCAS (Regression of Cerebral Artery Stenosis) study. J Neurol, 2009, 256(5): 750-757.
28.	Zhang H, Cui Y, Zhao Y, et al. Effects of sartans and low-dose statins on cerebral white matter hyperintensities and cognitive function in older patients with hypertension: a randomized, double-blind and placebo-controlled clinical trial. Hypertens Res, 2019, 42(5): 717-729.

1. Wu S, Wu B, Liu M, et al. Stroke in China: advances and challenges in epidemiology, prevention, and management. Lancet Neurol, 2019, 18(4): 394-405.
2. 徐芒芒, 姜帥, 陶文丹, 等. 認識急性腦小血管病與非急性腦小血管病及其影像標志物的區別及聯系. 華西醫學, 2021, 36(6): 725-730.
3. Wardlaw JM, Debette S, Jokinen H, et al. ESO guideline on covert cerebral small vessel disease. Eur Stroke J, 2021, 6(2): CⅪ-CLⅫ.
4. Smith EE, Saposnik G, Biessels GJ, et al. Prevention of stroke in patients with silent cerebrovascular disease: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2017, 48(2): e44-e71.
5. Fanning JP, Wesley AJ, Wong AA, et al. Emerging spectra of silent brain infarction. Stroke, 2014, 45(11): 3461-3471.
6. 中華醫學會神經病學分會, 中華醫學會神經病學分會腦血管病學組. 中國無癥狀腦梗死診治共識. 中華神經科雜志, 2018, 51(9): 692-698.
7. Vermeer SE, Koudstaal PJ, Oudkerk M, et al. Prevalence and risk factors of silent brain infarcts in the population-based Rotterdam Scan Study. Stroke, 2002, 33(1): 21-25.
8. Fanning JP, Wong AA, Fraser JF. The epidemiology of silent brain infarction: a systematic review of population-based cohorts. BMC Med, 2014, 12: 119.
9. Hao Z, Chen Y, Wright N, et al. Natural history of silent lacunar infarction: 10-year follow-up of a community-based prospective study of 0.5 million Chinese adults. Lancet Reg Health West Pac, 2021, 17: 100309.
10. Prins ND, Scheltens P. White matter hyperintensities, cognitive impairment and dementia: an update. Nat Rev Neurol, 2015, 11(3): 157-165.
11. Xu M, Li B, Zhong D, et al. Cerebral small vessel disease load predicts functional outcome and stroke recurrence after intracerebral hemorrhage: a median follow-up of 5 years. Front Aging Neurosci, 2021, 13: 628271.
12. Hopkins RO, Beck CJ, Burnett DL, et al. Prevalence of white matter hyperintensities in a young healthy population. J Neuroimaging, 2006, 16(3): 243-251.
13. de Groot JC, de Leeuw FE, Oudkerk M, et al. Cerebral white matter lesions and depressive symptoms in elderly adults. Arch Gen Psychiatry, 2000, 57(11): 1071-1076.
14. Steffens DC, Krishnan KR, Crump C, et al. Cerebrovascular disease and evolution of depressive symptoms in the cardiovascular health study. Stroke, 2002, 33(6): 1636-1644.
15. Roelofs EF, Bas-Hoogendam JM, van der Werff SJA, et al. Exploring the course of adolescent anxiety and depression: associations with white matter tract microstructure. Eur Arch Psychiatry Clin Neurosci, 2021: 8.
16. Greenberg T, Bertocci MA, Versace A, et al. Depression and anxiety mediate the relationship between frontotemporal white matter integrity and quality of life in distressed young adults. J Psychiatr Res, 2021, 132: 55-59.
17. 吳波, 劉鳴. 重視急性腦小血管病的診治與研究. 中華神經科雜志, 2021, 54(10): 983-993.
18. Gouw AA, Seewann A, van der Flier WM, et al. Heterogeneity of small vessel disease: a systematic review of MRI and histopathology correlations. J Neurol Neurosurg Psychiatry, 2011, 82(2): 126-135.
19. Wardlaw JM, Smith C, Dichgans M. Small vessel disease: mechanisms and clinical implications. Lancet Neurol, 2019, 18(7): 684-696.
20. Kent DM, Leung LY, Zhou Y, et al. Association of silent cerebrovascular disease identified using natural language processing and future ischemic stroke. Neurology, 2021, 97(13): e1313-e1321.
21. Debette S, Markus HS. The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ, 2010, 341: c3666.
22. 中華醫學會神經病學分會, 中華醫學會神經病學分會腦血管病學組. 中國腦血管病一級預防指南 2019. 中華神經科雜志, 2019, 52(9): 684-709.
23. White WB, Wakefield DB, Moscufo N, et al. Effects of intensive versus standard ambulatory blood pressure control on cerebrovascular outcomes in older people (INFINITY). Circulation, 2019, 140(20): 1626-1635.
24. C?té R, Battista RN, Abrahamowicz M, et al. Lack of effect of aspirin in asymptomatic patients with carotid bruits and substantial carotid narrowing. The Asymptomatic Cervical Bruit Study Group. Ann Intern Med, 1995, 123(9): 649-655.
25. King A, Shipley M, Markus H, et al. The effect of medical treatments on stroke risk in asymptomatic carotid stenosis. Stroke, 2013, 44(2): 542-546.
26. Han HJ, Kim BC, Youn YC, et al. A Comparison study of cilostazol and aspirin on changes in volume of cerebral small vessel disease white matter changes: protocol of a multicenter, randomized controlled trial. Dement Neurocogn Disord, 2019, 18(4): 138-148.
27. Mok VC, Lam WW, Fan YH, et al. Effects of statins on the progression of cerebral white matter lesion: post hoc analysis of the ROCAS (Regression of Cerebral Artery Stenosis) study. J Neurol, 2009, 256(5): 750-757.
28. Zhang H, Cui Y, Zhao Y, et al. Effects of sartans and low-dose statins on cerebral white matter hyperintensities and cognitive function in older patients with hypertension: a randomized, double-blind and placebo-controlled clinical trial. Hypertens Res, 2019, 42(5): 717-729.

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