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Year :2017
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Month :
March-April
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Volume :
6
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Issue :
2
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Page :
RO31 - RO36
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Ischemic Demyelination and Ischemic Stroke on Diffusion Weighted MR Imaging and Risk Factors of Ischemic Demyelination
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Correspondence Address :
Sivakami Rathinam, Ragini Singh,
Dr. Sivakami Rathinam,
No-80, Boopalan Street, Vallalar Nagar, Villupuram,
Villupural District-605602, Tamil Nadu, India.
E-mail: drsivakamijj@gmail.com
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Introduction: Introduction: Bilateral periventricular and subcortical white matter lesions of brain, which could be small, discrete or patchy confluent appearing hypodense on Computed Tomography (CT) and hyperintense on T2 weighted MRI are called Ischemic Demyelination (ID). This radiological finding is common in elderly people and presumed to arise secondary to small vessel ischemia. However, the risk factors, underlying pathogenesis and clinical importance of this condition is still under investigations.
Aim: To evaluate use of apparent diffusion co-efficient values in distinguishing ID from ischemic infarct, to find the correlation between ID and ischemic stroke and to list out the risk factors of ischemic demyelination.
Materials and Methods: We studied 60 patients with ID. Out of them 44 patients with ischemic strokes were further divided into 6 small groups based on duration of stroke. All subjects were studied on conventional MRI and Diffusion Weighted Imaging (DWI). ADCav values were determined for the regions of ID and infarcts. Detailed clinical history of all the subjects was obtained. Total serum cholesterol done for all.
Results: Mean ADC value of ischemic infarcts with duration up to one month, 1-3 month and >3 months were lesser, overlapping and higher than the values of ID lesion respectively with p-value <0.05. Significant association of ID and ischemic stroke, especially of lacunar type infarct was found. Significant association of ID found with elderly age, history of hypertension, diabetes mellitus. Smoking, alcoholism, gender, history of ischemic heart disease, peripheral vascular disease and high total serum cholesterol levels did not show significant association with ID.
Conclusion: ADCav value estimation can be applied in overcoming pseudo-normalization of subacute infarcts around one week and to distinguish >3 months old chronic infarcts from ID lesions. The significant association of ID with lacunar infarct favors the chances of common pathogenesis, the small vessel ischemia. With this evidence ischemic demyelination can be proposed as a risk factor to stroke attack. Increasing age, history of hypertension, diabetes mellitus are found to be the risk factors for development of ID.
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