Intracranial hemodynamic relationships in patients with cerebral small vessel disease. Link to paper on American Academy of Neurology Authors Gordon W. Blair, Michael J. Thrippleton, Yulu Shi, Iona Hamilton, Michael Stringer, Francesca Chappell, David Alexander Dickie, Peter Andrews, Ian Marshall, Fergus N. Doubal, Joanna M. Wardlaw Abstract Objective: To investigate cerebrovascular reactivity (CVR), blood flow, vascular & CSF pulsatility, & their independent relationship with cerebral small vessel disease (SVD) features in patients with minor ischemic stroke & MRI evidence of SVD. Methods: We recruited patients with minor ischemic stroke & assessed CVR using blood oxygen level–dependent MRI during a hypercapnic challenge, cerebral blood flow (CBF), vascular & CSF pulsatility using phase-contrast MRI, & structural magnetic resonance brain imaging to quantify white matter hyperintensities (WMHs) & perivascular spaces (PVSs). We used multiple regression to identify parameters associated with SVD features, controlling for patient characteristics. Results: Fifty-three of 60 patients completed the study with a full data set (age 68.0% ± 8.8 years, 74% male, 75% hypertensive). After controlling for age, sex, & systolic blood pressure, lower white matter CVR was associated with higher WMH volume (−0.01%/mm Hg per log10 increase in WMH volume, p = 0.02), basal ganglia PVS (−0.01%/mm Hg per point increase in the PVS score, p = 0.02), & higher venous pulsatility (superior sagittal sinus −0.03%/mm Hg, p = 0.02, per unit increase in the pulsatility index) but not with CBF (p = 0.58). Lower foramen magnum CSF stroke volume was associated with worse white matter CVR (0.04%/mm Hg per mL increase in stroke volume, p = 0.04) & more severe basal ganglia PVS (p = 0.09). Conclusions: Lower CVR, higher venous pulsatility, & lower foramen magnum CSF stroke volume indicate that dynamic vascular dysfunctions underpin PVS dysfunction & WMH development. Further exploration of microvascular dysfunction & CSF dynamics may uncover new mechanisms & intervention targets to reduce SVD lesion development, cognitive decline, & stroke. Keywords Cerebrovascular reactivity (CVR) Magnetic resonance (MR) Perivascular spaces (PVSs) Small vessel disease (SVD) Stroke White matter hyperintensities (WMHs) Related links Link to paper on American Academy of Neurology Professor Joanna Wardlaw Dr Michael Thrippleton Iona Hamilton Dr Michael Stringer Dr Francesca Chappell Professor Ian Marshall Dr Fergus Doubal Small vessel disease (SVD) Stroke What is a MR scan? Publication date 15 Jun, 2020
