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Brain lesions - Stroke risk

NEW YORK (Reuters Health) Jul 02 - Middle-aged individuals who exhibit cerebral white matter lesions (WMLs) on MRI are at increased risk for retinopathy and stroke compared with people without WMLs, according to a report published in the July 3rd issue of The Journal of the American Medical Association.

WMLs are a relatively common finding in older individuals and they are thought to have a microvascular etiology, the authors note. Furthermore, it has been hypothesized that such lesions precede the development of stroke, but previous studies have been unable to establish a definitive link.

To investigate further, Dr. Tien Yin Wong, from the National University of Singapore, and colleagues conducted a population-based study involving 1684 healthy middle-aged subjects who had cerebral MRI and retinal photography. The median follow-up period was 4.7 years.

Individuals with WMLs were at increased risk for developing retinopathy, the investigators report.

Subjects with WMLs were 3.4 times more likely to experience a stroke in the next 5 years than those without WMLs. Similarly, individuals with retinopathy were 4.9 times more likely than those without retinopathy to experience a stroke. Individuals with WMLs and retinopathy were at greatest risk for stroke, with a relative risk of 18.1 compared with those without either finding.

"These population-based data show that WMLs are independently associated with retinal microvascular abnormalities, providing evidence that small-vessel diseases are linked to the pathogenesis of WMLs," the authors state. Furthermore, "persons with WMLs are at increased risk of developing a clinical stroke, independent of conventional stroke risk factors, particularly when retinopathy is also present."

JAMA 2002;288:67-74.

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