Aging Begins at 30

Brain White Matter Strokes

Ian Maclean Smith, M.D.
Emeritus Professor
Department of Internal Medicine
University of Iowa Hospitals and Clinics
Creation Date: February 2002
Last Revision Date: February 2002
Peer Review Status: Internally Peer Reviewed

If an autopsy was done after death, the bright white MRI areas were found to match areas where the small blood vessels of the brain were diseased. For want of a better name, these bright areas are now called white matter lesions or WMLs for short. Anatomists have noted that the blood vessels found in the WMLs have the same embryonic origin as the small vessels in the retina at the back of the eye. With special techniques, these retinal vessels can be photographed and show the same kind of damage. They also have a similarity to the small blood vessels damaged in long-standing diabetes.

A group of investigators studying hardening of the arteries or arteriosclerosis in communities from six U.S. academic medical centers and from Singapore (see JAMA July 3^rd 2002) decided to follow patients who had MRIs done and to check them also for retinal lesions for 5 years. They examined about 1,700 people aged 51 to 72. Among them showed WMLs in 1988, 1991 and 1994. They were initially free of stroke. Retinal photographs were taken at the third examination. The readers of the X-rays and the retinal photographs had no knowledge of the health of the subjects, that is they were not told about any diseases the subjects had. All strokes were verified by hospital records. Eleven percent had white matter lesions and 9% had retinal blood vessel disease. They graded the severity of both these problems.

Of the study subjects who had retinal blood vessel disease, 23% had a stroke within 5 years. Of those who did not have retinal disease only 10% had a stroke. Of those with WMLs, 7% had a stroke at 5 years compared with 1% of those without WMLs. Of persons with both WMLs and retinal disease 20% had stroke versus 1% with neither.

They concluded that middle-age people with abnormal brain MRIs showing WMLs as they aged were more likely to have retinal blood vessel disease and had an increased risk of stroke. Persons with retinal disease and WMLs were 18 times more likely to develop stroke than people with neither WMLs nor retinal blood vessel disease. Eye disease, black race, diabetes and high blood pressure all made patients with this kind of abnormal MRI more likely to have a stroke within the next five years. A new disease process is beginning to be defined.

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See related Patient Topics Brain and Nervous System, Brain Diseases, Heart and Circulation, Seniors' Health or Stroke.

See related Provider Topics Brain and Nervous System, Brain Diseases, Heart and Circulation, Seniors' Health or Stroke.

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