Study On The Correlation Between White Matter Lesion And Dyskinesia Of Cerebral Small Vessel Disease

Background:Cerebral small vessel disease(CSVD)plays an important role in cerebrovascular disease.Generally,the onset is insidious and progresses slowly,such as cognitive decline,mood disorders,dyskinesias(including gait abnormalities,balance disorders,and increased risk of falling),and urinary incontinence.The main manifestation of an acute attack is lacunar infarction,among which there are many causes of lacunar infarction,including embolism caused by various reasons,carrier artery stenosis and blocking perforator,deep perforating branch atherosclerosis,etc.Only the latter of the above causes can be classified as CSVD,so a lacunar infarction cannot be roughly classified as CSVD based on the size of the infarct and urine.White matter lesions(WML)is one of the imaging features of CSVD.Due to the routine use of craniocerebral MRI,the detection rate of WML is significantly higher than before.At present,there are more researches related to CSVD imaging characteristics and cognitive impairment in China.Relatively speaking,there are few studies on dyskinesia.Therefore,this study explores the characteristics of gait abnormalities and balance disorders shown by CSVD patients,and it is found that WML is highly correlated with the dyskinesia caused by CSVD through reading a large number of literatures.Then,multi-mode MRI was performed on CSVD patients to explore the correlation between the severity and location of WML in CSVD patients with gait abnormalities,balance disorders and the risk of falls.Purpose:Analyze the characteristics of abnormal gait and balance disorder of CSVD patients,and analyze the correlation between the severity and location of WML and the abnormal gait,balance disorder and fall risk of CSVD patients with imaging examination.Methods:198 patients with CSVD who were admitted to the Department of Neurology,Affiliated Hospital of Yan’an University from December 2019 to December 2020 were included.The Tinettie Mobility Test(TMT)was performed on all the enrolled patients,and the characteristics of gait abnormalities and balance disorders that CSVD patients tend to show were analyzed based on the results.In addition,all selected subjects underwent cranial MRI(Magnetic resonance imaging),MRA(Magnetic resonance angiography),SWI(Susceptibility weighted imaging)and other examinations,and WML visual assessment scale(Fazekas,modified SCheltens scale)was used to interpret the imaging results.According to the Fazekas scale,the enrolled patients were divided into Fazekas Ⅰ group,Fazekas Ⅱ group and Fazekas Ⅲ group,and the differences in gait abnormality,balance disorder and fall risk among the three groups were analyzed.According to the results of the modified SCheltens scale and TMT scale,the correlation between WML position and abnormal gait,balance disorder and fall risk was analyzed.Results:1.Analysis of general data and some clinical data:A total of 198 patients with CSVD were included in this study,aged 60-92 years old,with an average age of 69.67±6.283 years old,of which 119 cases(60.1%)were male and 79 cases(39.9%)were female.Among them,64 cases(32.3%)in the Fazekas Ⅰ group,with an average age of 67.91±5.456 years;100 cases(50.5%)in the Fazekas Ⅱ group,with an average age op 69.99±6.649 years;34 cases(17.2%)in the Fazekas Ⅲ group,with an average age of 72.06±5.825 years old.2.Analysis of risk factors for WML:By analyzing the clinical data of patients with different Fazekas classifications,the results show that the differences in age,gender,hypertension,diabetes,smoking history,and homocysteine are statistically significant.The above-mentioned risk factors with different results were analyzed by multivariate ordered logistic regression analysis,and the results showed that the differences in age(OR=1.065,P<0.05),hypertension(OR=2.649,P<0.05)and smoking history(OR=2.148,P<0.05)between the three groups were statistically significant.3.Features of abnormal gait that are easily affected by CSVD patients:step width(41.4%),step height(38.4%and 39.4%for left and right respectively),gait symmetry(32.8%);balance disorders that are easily affected by CSVD patients Features:Unsteady standing with eyes closed(40.9%),unsteady pushing(40.4%),turning 360°(39.9%).4.Correlation between WML of different severity and dyskinesias:Tinettie gait score(H=28.598,P=0.000),Tinettie balance score(H=21.729,P=0.000)and Tinettie total score(H-23.657,P=0.000)in CSVD patients with different severity of WML are obviously different.After comparing the three groups of patients in pairs,the results showed that the difference in the Tinettie gait score between Fazekas Ⅰ group and FazekasⅡ group,Fazekas Ⅰ group and Fazekas Ⅲ group was statistically significant(P<0.0167),and the difference in the Tinettie gait score between Fazekas Ⅱ group and Fazekas Ⅲgroup was statistically significant(P<0.0167);there was no statistically significant difference in the Tinettie balance score between Fazekas Ⅰ group and Fazekas Ⅱgroup(P>0.0167),but the difference in the Tinettie balance score between Fazekas Ⅰgroup and Fazekas Ⅲ group,Fazekas Ⅱ group and Fazekas Ⅲ group was statistically significant(P<0.0167);there was no statistically significant difference in the total Tinettie score between Fazekas Ⅰ group and Fazekas Ⅱ group(P>0.0167),but the difference between Fazekas Ⅰ group and Fazekas Ⅲ group,Fazekas Ⅱ group and FazekasⅢ group in the Tinettie total score was statistically significant(P<0.0167).5.Correlation between WML and dyskinesia in different parts:Spearman correlation analysis showed the following results,the anterior horn of the lateral ventricle(rs=-0.590,P=0.000),the lateral ventricle(rs=-0.464,P=0.000),the posterior horn of the lateral ventricle(rs=-0.424,P=0.000),the frontal lobe(rs=-0.681,P=0.000),the WML score of the above parts was significantly negatively correlated with Tinettie gait score;the anterior horn of the lateral ventricle(rs=-0.410,P=0.000),the lateral ventricle(rs=-0.420,P=0.000),the posterior horn of the lateral ventricle(rs=-0.405,P=0.000),the frontal lobe(rs=-0.420,P=0.000),the WML score of the above parts are significantly negatively correlated with Tinettie Balance Score;the anterior horn of the lateral ventricle(rs=-0.562,P=0.000),lateral ventricle(rs=-0.484,P=0.000),posterior horn of lateral ventricle(rs=-0.427,P=0.000),the frontal lobe(rs=-0.601,P=0.000),the WML score of the above parts are significantly negatively correlated with Tinettie total score.The above differences were statistically significant(P<0.05).Conclusion:1.The independent risk factors for WML were age,hypertension and smoking history.2.Characteristics of abnormal gait and balance disorders in patients with CSVD:abnormal gait with changes in step width,step height,and gait symmetry as the main characteristics;balance disorder with changes in instability in standing with closed eyes,instability in light push,and instability in 360°turning as the main characteristics.3.With the increase of the severity of WML,the performance of CSVD patients with abnormal gait and balance disorders is more pronounced,and the risk of falling is also increased.4.The positions with strong correlation between WML and gait abnormal are:frontal lobe,anterior horn of lateral ventricle,lateral ventricle,posterior horn of lateral ventricle;the positions with strong correlation between WML and balance disorder are:lateral ventricle,frontal lobe,anterior horn of the lateral ventricle,posterior horn of the lateral ventricle;the positions with strong correlation between WML and the risk of falling are:frontal lobe,anterior horn of lateral ventricle,lateral ventricle,posterior horn of lateral ventricle.