본문 바로가기
KERD
논문KCI 등재

카다실 환자에서 고혈압과 뇌미세출혈의 연관성

The Association Between Hypertension and Cerebral Microbleeds in Patients With CADASIL

박선우|강사윤|송숙근|이정석|강지훈|최재철
대한신경과학회 (Korean Neurological Association)|2014.05|대한신경과학회지 (Journal of the Korean Neurological Association)|제32권 제2호|pp. 82-84

2

조회

0

다운로드

1

인용

0

참고문헌

키워드

HypertensionCerebral microbleeds (CMBs)
주제분류신경과학

초록

Background: Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)is an inherited microangiopathy that is caused by mutations in the Notch3 gene. Typical findings from magneticresonance imaging (MRI) include multiple subcortical lacunae, extensive white-matter change, and multiple cerebralmicrobleeds (CMBs). CMBs are indicative of bleeding-prone microangiopathy. The rate of intracerebral hemorrhage inCADASIL is higher in Asian patients than in Caucasian patients. However, CMBs have not been thoroughly evaluated inAsian patients. We performed a detailed analysis of the frequency and distribution pattern of CMBs and assessedwhether vascular risk factors exert an independent effect on CMBs in Asian CADASIL patients. Methods: The study population comprised 60 patients who underwent brain MRI, including T2*-weighted gradient-echosequences. Demographic factors, vascular risk factors, and MRI findings were compared between CADASIL patientswith and without CMBs. The impact of vascular risk factors on CMBs, lacunae, and white-matter hyperintensities(WMHs) was assessed by logistic regression analysis. Results: CMBs, which were detected in 34 (56.7%) patients, exhibited a significant predilection for the thalamus (46.7%),subcortical-cortical region (35.0%), and basal ganglia (31.7%). Hypertension, lacunae, and white-matter lesions weremore common in patients with CMBs. Hypertension was an independent risk factor for CMBs, lacunae, and WMHs inpatients with CADASIL. Conclusions: This study found that CMBs tended to occur in hypertensive patients with CADASIL. Further studiesshould focus on elucidating the association between reduced blood pressure and the number of CMBs.

Abstract

Background: Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)is an inherited microangiopathy that is caused by mutations in the Notch3 gene. Typical findings from magneticresonance imaging (MRI) include multiple subcortical lacunae, extensive white-matter change, and multiple cerebralmicrobleeds (CMBs). CMBs are indicative of bleeding-prone microangiopathy. The rate of intracerebral hemorrhage inCADASIL is higher in Asian patients than in Caucasian patients. However, CMBs have not been thoroughly evaluated inAsian patients. We performed a detailed analysis of the frequency and distribution pattern of CMBs and assessedwhether vascular risk factors exert an independent effect on CMBs in Asian CADASIL patients. Methods: The study population comprised 60 patients who underwent brain MRI, including T2*-weighted gradient-echosequences. Demographic factors, vascular risk factors, and MRI findings were compared between CADASIL patientswith and without CMBs. The impact of vascular risk factors on CMBs, lacunae, and white-matter hyperintensities(WMHs) was assessed by logistic regression analysis. Results: CMBs, which were detected in 34 (56.7%) patients, exhibited a significant predilection for the thalamus (46.7%),subcortical-cortical region (35.0%), and basal ganglia (31.7%). Hypertension, lacunae, and white-matter lesions weremore common in patients with CMBs. Hypertension was an independent risk factor for CMBs, lacunae, and WMHs inpatients with CADASIL. Conclusions: This study found that CMBs tended to occur in hypertensive patients with CADASIL. Further studiesshould focus on elucidating the association between reduced blood pressure and the number of CMBs.

참고문헌 (21)

  1. Joutel A, "Notch 3 mutations in CADASIL, a hereditary adult-onset condition causing stroke and dementia", Nature, 383, pp.707~710 (1996)
  2. 이정석, "카다실 환자에서 뇌졸중발생 유무에 따른 임상증상과 뇌자기공명영상소견의 차이", 대한신경과학회지, 30(2), pp.93~99 (2012), 대한신경과학회[DOI]
  3. 이정석, "Effects of Lacunar Infarctions on Cognitive Impairment in Patients with Cerebral Autosomal-Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy", Journal of Clinical Neurology, 7(4), pp.210~214 (2011), 대한신경과학회
  4. Brulin P, "Morphometric analysis of ultrastructural vascular changes in CADASIL: analysis of 50skin biopsy specimens and pathogenic implications", Acta Neuropathol, 104, pp.241~248 (2002)
  5. Chabriat H, "CADASIL", Lancet Neurol, 8, pp.643~653 (2009)
  6. van den Boom R, "Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy: MR imaging findings at different ages–3rd-6th decades", Radiology, 229, pp.683~690 (2003)
  7. Lee SH, "Cerebral microbleeds in patients with hypertensive stroke. Topographical distribution in the supratentorial area", J Neurol, 251, pp.1183~1189 (2004)
  8. Roob G, "MRI evidence of past cerebral microbleeds in a healthy elderly population", Neurology, 52, pp.991~994 (1999)
  9. Kwa VI, "Silent intracerebral microhemorrhages in patients with ischemic stroke", Ann Neurol, 44, pp.372~377 (1998)
  10. Choi JC, "Intracranial hemorrhages in CADASIL", Neurology, 7, pp.2042~2044 (2006)
  11. Choi JC, "Diversity of stroke presentation in CADASIL: study from patients harboring the predominant NOTCH3 mutation R544C", J Stroke Cerebrovas Dis, 22, pp.126~131 (2013)
  12. Lee YC, "Population-specific spectrum of NOTCH3 mutations, MRI features and founder effect of CADASIL in Chinese", J Neurol, 256, pp.249~255 (2009)
  13. Lesnik Oberstein SA, "Cerebral microbleeds in CADASIL", Neurology, 57, pp.1066~1070 (2001)
  14. Lee JS, "Olfactory identification deficits in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy", Eur Neurol, 64, pp.280~285 (2010)
  15. Lee SH, "Silent microbleeds are associated with volume of primary intracerebral hemorrhage", Neurology, 66, pp.430~432 (2006)
  16. Bokura H, "Distinguishing silent lacunar infarction form enlarged Virchow-Robin spaces: a magnetic resonance imaging and pathological study", J Neurol, 245, pp.116~122 (1998)
  17. Koennecke HC, "Cerebral microbleeds on MRI: prevalence, associations, and potential clinical implications", Neurology, 66, pp.165~171 (2006)
  18. Kim Y, "Characteristics of CADASIL in Korea : a novel cysteine-sparing Notch3 mutation", Neurology, 66, pp.1511~1516 (2006)
  19. Viswanathan A, "Blood pressure and haemoglobin A1c are associated with microhaemorrhage in CADASIL: a two-centre cohort study", Brain, 129, pp.2375~2383 (2006)
  20. Viswanathan A, "Cerebral microhemorrhage", Stroke, 37, pp.550~555 (2006)
  21. Dichgans M, "Cerebral microbleeds in CADASIL: a gradient-echo magnetic resonance imaging and autopsy study", Stroke, 33, pp.67~71 (2002)

관련 논문AI추천

CADASIL에서 고혈압이 열공경색과 뇌미세출혈의 발병위치에 미치는 영향강사윤, 강지훈, 송숙근, 오정환, 이정석, 최재철대한치매학회 · Dementia and Neurocognitive Disorders(대한치매학회지)2014 · 제13권 제4호카다실 환자에서 뇌졸중발생 유무에 따른 임상증상과 뇌자기공명영상소견의 차이강사윤, 강지훈, 나해리, 송숙근, 송정국, 이정석, 최재철대한신경과학회 · 대한신경과학회지2012 · 제30권 제2호R544C Mutation을 가진 CADASIL 환자의 혈관성 위험인자강사윤, 강지훈, 나해리, 이정석, 최재철대한치매학회 · Dementia and Neurocognitive Disorders(대한치매학회지)2009 · 제8권 제2호Occurrence of Intracranial Hemorrhage and Associated Risk Factors in Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy: A Systematic Review and Meta-AnalysisJun-Jun Wang, Lin Cheng, Li-Ying Zhuang, Lu Liu, Qilun Lai, Shi-Ting Weng, Song Qiao, Ye-Jia Mo, Yinxi Zhang대한신경과학회 · Journal of Clinical Neurology2022 · 제18권 제5호카다실 환자의 주요혈관인지장애와 경도혈관인지장애에서 뇌 자기공명영상 표지자가 미치는 영향고명주, 이정석, 이호규, 최재철대한신경과학회 · 대한신경과학회지2022 · 제40권 제1호Effects of Lacunar Infarctions on Cognitive Impairment in Patients with Cerebral Autosomal-Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy강사윤, 강지훈, 나해리, 박지강, 이정석, 최재철대한신경과학회 · Journal of Clinical Neurology2011 · 제7권 제4호

이 간행물의 다른 논문 (16건)

경동맥스텐트삽입술 시술 전 평가와 시술 전후 관리박희권, 하연수pp. 59-713,4,5-Tricaffeoylquinic acid가 파킨슨증후군유발독소 1-methyl-4-phenylpyridinium에 의한세포자멸사에 미치는 억제효과주재정, 강진호, 한정호, 김두응, 이정수pp. 72-81선천외경-내경동맥 문합최재철, 송숙근, 강철후, 김중구, 이정석, 강지훈pp. 88-90스테로이드 치료에 반응을 보인 재발성 LGI1 항체연관변연계뇌염신진홍, 김승주, 조재욱, 이재혁, 노경하pp. 91-94갑상선독성발작과 연관된 모야모야병의 급성뇌경색노학재, 안무영, 이경복, 김지선, 이정곤, 서재영, 신동원pp. 95-97
원문 보기