1993 Volume 15 Issue 5 Pages 353-359
Leukoaraiosis is commonly observed on magnetic resonance imaging (MRI) in elderly patients. Although a heterogeneous pathogenesis is suggested, the postulation of ischemic leukoencephalopathy resulting from arteriolar lesions that preferentially involve the long medullary arteries, is broadly supported. Lacunar infarct is a penetrating artery obstruction with hypertensive arteriosclerosis. The mechanisms of those two kinds of small artery disease were analyzed by 24-hour blood pressure recording.
Eighty-three patients with leukoaraiosis or/and lacunar infarct located in the area of the basal ganglion as diagnosed by MRI (1.5) were investigated. In each patient, the degrees of leukoaraiosis, lacunar infarct and dementia were classified into 4 grades (03). Blood pressure recording was performed every 30 min for 24 hours using a portable blood pressure recorder (ABPM-630, Colin, Japan). All blood pressure values for 24 hours were averaged (A-BP) and the short-term blood pressure variability (ST-V) was expressed as the mean difference in two successive blood pressure values.
Age, A-BP, ST-V and the severity of dementia increased in relation to the degree of leukoaraiosis. However, age and ST-V were unrelated to the severity of lacunar infarct. A-BP was correlated with the degree of lacunar infarction from grade 0 to grade 2, but decreased rather in grade 3 as compared to grade 2, so that the severity of dementia was remarkable in grade 3. It was inferred that A-BP decreased in the severe multiple lacunar state, and could consequently have prompted the process of vascular dementia.
High short-term blood pressure variability may be a risk factor for leukoaraisosis, but is irrelevant to lacunar infarction.
