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Pre-existing Small Vessel Disease in Patients with Acute Stroke from the Middle East, Southeast Asia, and Philippines

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An Author Correction to this article was published on 13 January 2018

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Abstract

Asymptomatic small vessel disease (SVD), including white matter hyperintensities (WMHIs), periventricular hyperintensities (PVHIs), silent stroke (SS), and cerebral microbleeds (CMBs), increases the risk of stroke. There are limited studies of SVD in subjects from the Middle East and Southeast Asia (SA). All patients admitted to stroke service between 2014 and 2015 were reviewed for presence of “pre-existing” SVD. Stroke mimics with no previous history of stroke were used as controls. There were 1727 patients admitted with stroke. Analysis was done on 988 subjects (914 strokes and 74 controls) who had MRI scan done. Pre-existing SVD was seen in 642 (64.9%) patients (WMHIs 19.6%, PVHIs 33.2%, SS 51.4%, and CMBs 22%). Silent strokes were significantly more common with ischemic stroke (IS) compared to intracranial hemorrhage (ICH) (62.0 vs 34.3%, p < 0.001). CMBs were more in ICH compared to IS (42.9 vs 23.1%, p < 0.001). The risk of developing CMBs among Far Eastern (FE) patients was 1.58 times more (p = 0.07), while 1.48 times more in Arabs (AR) (p = 0.026) compared to SA after adjusting for age. The risk of developing PVHIs was significantly higher in Arab compared to SA (odds ratio (OR) 1.43; p value = 0.021). Similarly, the risk of developing WMHIs was also significantly higher in AR patients (OR 1.6; p value = 0.009) compared to SA. The majority of ethnic AR, SA, and FE populations show pre-existing SVD on MRI. The advanced changes at a young age may be related to high prevalence of untreated risk factors and possibly as yet defined genetic and environmental factors.

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Change history

  • 13 January 2018

    The author names “Dr. Pablo Garcia Bermejo” and “Dr. Muhammad Faisal Wadiwala” needed to be added as the 6th and 7th authors, respectively. The authors regret this error.

References

  1. Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010;9:689–701.

    Article  PubMed  Google Scholar 

  2. Lan KK, Li L, Schulz U, Simoni M, Chan KH, Ho SL, et al. Total small vessel disease score and the risk of recurrent stroke. Neurology. 2017;88:2260–7.

    Article  Google Scholar 

  3. Romero JR, Preis SR, Beiser A, DeCarli C, Viswanathan A, Martinez-Ramirez S, et al. Risk factors, stroke prevention treatments, and prevalence of cerebral microbleeds in the Framingham Heart Study. Stroke. 2014;45:1492–4.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Portegies MLP, Wolters FJ, Hofman A, Ikram MK, Koudstaal PJ, Ikram MA. Prestroke vascular pathology and the risk of recurrent stroke and poststroke dementia. Stroke. 2016;47:2119–22.

    Article  PubMed  Google Scholar 

  5. Kuller LH, Longstreth WT, Arnold AM, Bernick C, Bryan RN, Beauchamp NJ. White matter hyperintensity on cranial magnetic resonance imaging: a predictor of stroke. Stroke. 2004;35:1821–5.

    Article  PubMed  Google Scholar 

  6. Greenberg SM, Vernooij MW, Cordonnier C, Viswanathan A, Salman RA, Warach S, et al. Cerebral microbleeds: a guide to detection and interpretation. Lancet Neurol. 2009;8:165–74.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Gupta A, Giambrone AE, Gialdini G, Finn C, Delgado D, Gutierrez J, et al. Silent brain infarction and the risk of future stroke. A systemic meta-analysis. Stroke. 2016;47:719–25.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. Feigin VL. Stroke in developing countries: can the epidemic be stopped and outcomes improved. Lancet Neurol. 2007;6:94–7.

    Article  PubMed  Google Scholar 

  9. O’Donnell M, Yousef S. Tracking the global burden of stroke: the need for large scale international studies. Lancet Neurol. 2009;8:306–7.

    Article  PubMed  Google Scholar 

  10. Wasay M, Khatri IA, Kaul S. Stroke in South Asian countries. Nat Rev Neurol. 2014;10:135–43.

    Article  PubMed  Google Scholar 

  11. Johnson SC, Mendis S, Mathers CD. Global variations in stroke burden and mortality: estimates from monitoring, surveillance and modelling. Lancet Neurol. 2009;8:345–54.

    Article  Google Scholar 

  12. O’Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, A-Melacini P, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010;376:112–23.

    Article  PubMed  Google Scholar 

  13. Mehndiratta MM, Khan M, Mehndiratta P, Wasay M. Stroke in Asia: geographical variations and temporal trends. J Neurol Neurosurg Psychiatry. 2014;85:1308–12.

    Article  PubMed  Google Scholar 

  14. Feigin VL, Roth GA, Naghavi M, Parmar P, Krishnamurthi R, Chugh S, et al. Global burden of stroke and risk factors in 188 countries during 1988-2013. Lancet Neurol. 2016;15:913–24.

    Article  PubMed  Google Scholar 

  15. Akhtar N, Salam A, Kamran S, Bourke P, Joseph S, Santos M, et al. Ethnic variation in acute cerebrovascular disease: analysis from the Qatar stroke registry. Eur Stroke Jour. 2016;1:231–41.

    Article  Google Scholar 

  16. Akhtar N, Kamran S, Singh R, Cameron P, D’Souza A, Imam Y, et al. Beneficial effects of implementing stroke protocols require establishment of a geographically distinct unit. Stroke. 2015;46:3494–501.

    Article  PubMed  Google Scholar 

  17. Population Chapter 2015. Ministry of Development Planning and Statistics. http://www.mdps.gov.qa/en/Statistics1. Accessed 3 Aug 2016.

  18. Adam HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in acute stroke treatment. Stroke. 1993;24:35–41.

    Article  Google Scholar 

  19. Brant-Zawadzki M, Fein G, Van Dyke C, Kiernan R, Davenport L, de Groot J, et al. MR imaging of the aging brain: patchy white-matter lesions and dementia. AJNR. 1985;6:675–82.

    PubMed  CAS  Google Scholar 

  20. Zimmerman RD, Fleming CA, Lee BCP, Saint-Louis LA, Deck MD. Peri ventricular hyperintensity as seen by magnetic resonance: prevalence and significance. AJR. 1986;146:443–50. AJNR .1986;7: 13–20

    Article  PubMed  CAS  Google Scholar 

  21. Fazekas F, Chawlak JB, Alavi A, Hurtig HI, Zimmerman RA. MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. Am J Roentgenol. 1987;149:351–6.

    Article  CAS  Google Scholar 

  22. Kakar P, Charidimou A, Werring DJ. Cerebral microbleeds: new dilemma in stroke medicine. JRSM Cardiovasc Dis. 2012;1:22.

    Google Scholar 

  23. Charidimou A, Jäger HR, Werring DJ. Cerebral microbleed detection and mapping: principles, methodological aspects and rationale in vascular dementia. Exp Gerontol. 2012;47:843–52.

    Article  PubMed  Google Scholar 

  24. Pasquini M, Bebedictus MR, Boulouis G, Rossi C, Dequatre-Ponchelle N, Cordonnier C. Incident cerebral microbleeds in a cohort of intracerebral hemorrhage. Stroke. 2016;47:689–94.

    Article  PubMed  CAS  Google Scholar 

  25. Wang Y, Liu G, Hong D, Chen F, Ji X, Cao G. White matter injury and ischemic stroke. Prog Neurobiology. 2016;141:45–60.

    Article  Google Scholar 

  26. Kleining TJ. Associations and implications of cerebral microbleeds. J Clin Neurosci. 2013;20:919–27.

    Article  Google Scholar 

  27. Wong T, Klein R, Sharrett AR, Couper DJ, Klein BE, Liao DP, et al. Cerebral white matter lesions, retinopathy and incident clinical stroke. JAMA. 2002;288:67–74.

    Article  PubMed  Google Scholar 

  28. Smith EE, Saposnik G, Biessels GJ, Doubal FN, Fornage M, Gorelick PB, et al. Prevention of stroke in patients with silent cerebrovascular disease. Stroke. 2017;48:e44–71.

    Article  PubMed  Google Scholar 

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Acknowledgments

The team is grateful to Ms. Reny Francis from the Neuroscience Institute, Hamad Medical Corporation, for providing formatting support and reviewing the manuscript.

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Authors and Affiliations

  1. The Stroke Program, The Neuroscience Institute, Hamad Medical Corporation, 3050, Doha, Qatar

    Naveed Akhtar, Abdul Salam, Saadat Kamran, Atlantic D’Souza, Yahia Imam, Paula Bourke, Sujatha Joseph, Mark Santos, Rabia Ali Khan & Ashfaq Shuaib

  2. Weill Cornell Medicine- Qatar, 24144, Ar-Rayyan, Qatar

    Naveed Akhtar, Saadat Kamran & Yahia Imam

  3. The Neuroradiology Program, The Neuroscience Institute, Hamad Medical Corporation, 3050, Doha, Qatar

    Ahmed Own, Ahmed ElSotouhy & Surjith Vattoth

  4. Department of Emergency Medicine, Hamad Medical Corporation, 3050, Doha, Qatar

    Zain Bhutta

  5. Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, T6G 2R3, Canada

    Ashfaq Shuaib

Authors
  1. Naveed Akhtar
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  2. Abdul Salam
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  3. Saadat Kamran
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  4. Atlantic D’Souza
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  5. Yahia Imam
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  7. Ahmed ElSotouhy
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  8. Surjith Vattoth
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  9. Paula Bourke
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  10. Zain Bhutta
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  11. Sujatha Joseph
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  12. Mark Santos
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  13. Rabia Ali Khan
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  14. Ashfaq Shuaib
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Corresponding author

Correspondence to Ashfaq Shuaib.

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The study has received IRB approval at Hamad Medical Corporation.

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The authors declare that they have no conflict of interest.

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Akhtar, N., Salam, A., Kamran, S. et al. Pre-existing Small Vessel Disease in Patients with Acute Stroke from the Middle East, Southeast Asia, and Philippines. Transl. Stroke Res. 9, 274–282 (2018). https://doi.org/10.1007/s12975-017-0578-7

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  • DOI: https://doi.org/10.1007/s12975-017-0578-7

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