The Cerebrovascular Reactivity In Patients With Leukoaraiosis

BackgroundLeukoaraiosis (LA) is a group of clinical syndrome used to describe diffuse white matter abnormalities on computer tomography or magnetic resonance imaging brain scans. It is one subtype of small vessel disease, age and hypertension are the most two important risk factors. Cerebrovascular reactivity (CVR) refers to the ability that under physiological or pathological conditions, cerebral arterioles and capillaries to maintain cerebral blood flow in normal and stable by compensatory expansion or contraction. It has been confirmed that CVR impairment and LA are associated in elderly or patients with overt cerebral ischemia. In contrast, such a relationship was few confirmed for middle-aged, asymptomatic patients with risk factors for stroke.PurposeTo study the relationship between the CVR and LA of different degrees in middle-aged hypertensive patients.Subjects and Methods73middle-aged hypertensive patients with LA of different severities according to the Fazekas scale were divided into LA0level(34cases), LA1level(33cases)and LA2level(6cases)groups. Transcranial Doppler (TCD) in combination with breath-holding test was performed in all the patients to assess the breath-holding index (BHI) of bilateral middle cerebral artery. Analysis the differences in CVR and LA of different severities.ResultsThe mean systolic blood pressure gradually increased among different LA grades (P<0.01). With the aggravation of LA lesions, the MFV and BHI apparently decreased (P<0.05). Regression analysis implied that impairment of BHI was significantly related to the severities of LA, increased age and elevated mean systolic blood pressure(P<0.01). Furthermore, after controlling patients’age and mean systolic blood pressure, the impairment of BHI was significantly correlated with the severities of LA. Finally, take LA2level group as the standard, LA0level and LA1level groups were matched subgroups according to age and blood pressure, the results show that the impairment of BHI and the severities of LA remained significantly related(P<0.01).ConclusionsThe severities of LA and the impairment of BHI in middle-aged hypertensive patients was significantly correlated with the elevated mean systolic pressure. Which implied that Controlling blood pressure levels may delay the progression of LA and improve cerebral hemodynamics. LA is a sign of cerebrovascural impairment. Even a low load of WMLs may reflect some functional impairment of the cerebral microcirculation. Further more, CVR can serve as an effective assessment of cerebral hemodynamics in LA patients. Using TCD combined with breath-holding test to detect the BHI contributes to predict the severities of LA.