White Matter Hyperintensity-Associated Blood-Brain Barrier Disruption and Vascular Risk Factors

Background: White matter hyperintensities (WMH), the hallmark of vascular cognitive impairment, are associated with vascular risk factors (VRF). WMH can also be associated with blood-brain barrier (BBB) disruption. The purpose of this study was to look for associations between VRF and BBB disruption in stroke patients with WMH. Methods: Magnetic resonance images of stroke patients were reviewed for the presence of WMH. Blood-brain permeability images were retrospectively generated. The degree of BBB permeability was compared with the presence of VRF using logistic regression. Patterns and extent of WMH were classified using Fazekas scores. Results: Sixty-five patients were included in this study. None of the VRF tested were associated with an increase in BBB disruption. Hypertension was significantly associated with less BBB disruption (P=.04). Nonhypertensive patients in our study had a different pattern of WMH than hypertensive patients, with less involvement of the periventricular white matter. Conclusions: We found that in stroke patients with WMH, those with hypertension had less BBB disruption and greater involvement of the periventricular white matter when compared with patients who did not have a history of hypertension. Further investigation is needed to determine if the development of WMH in stroke patients with a history of hypertension has a different pathophysiology from patients who develop WMH in the absence of hypertension.