On the Etiology of Incident Brain Lacunes Longitudinal Observations From the LADIS Study

Background and Purpose-We investigated regional differences in MRI characteristics and risk factor profiles of incident lacunes over a 3-year period. Methods-Baseline and 3-year follow-up MRI were collected within the LADIS study (n = 358). Incident lacunes were characterized with respect to brain region, their appearance within pre-existent white matter hyperintensities (WMH), surrounding WMH size, and risk factors. Results-106 incident lacunes were observed in 62 patients ( 58 subcortical white matter [WM], 35 basal ganglia, and 13 infratentorial). Incident subcortical WM lacunes occurred more often within preexisting WMH (P = 0.01) and were mostly accompanied by new and expanded WMH (P < 0.001), compared to incident basal ganglia and infratentorial lacunes. Risk factors for incident subcortical WM lacunes were history of hypertension and stroke, whereas atrial fibrillation predicted incident basal ganglia/infratentorial lacunes. Conclusion-Differences in relation to WMH and risk factor profiles may suggest that incident lacunes in the subcortical WM have a different pathogenesis than those in the basal ganglia and infratentorial region. (Stroke. 2008; 39: 3083-3085.)