Asymptomatic multiple lacunae in diabetics and non-diabetics detected by brain magnetic resonance imaging

doi:10.1016/0168-8227(96)01196-5

Diabetes Research and Clinical Practice

Volume 31, Issues 1–3, March 1996, Pages 81-86

https://doi.org/10.1016/0168-8227(96)01196-5 Get rights and content

Abstract

We investigated the relationship between asymptomatic multiple lacunae (ASML) and related risk factors by using brain MRI in 209 patients including 152 NIDDM patients. Patients with ASML (97 cases) were significantly older (68 ± 9 vs. 63 ± 10) and hypertension was more frequent (57/97 vs. 33/112) than in patients without ASML. In addition, by multivariate analysis, ASML showed significant association with aging and hypertension, but not with NIDDM. In the NIDDM patients, diabetics with ASML were significantly older, and showed a higher association with hypertension and triopathy than those without ASML, although the results were the same for the middle-aged (<65 years old) diabetics. From multivariate analysis, the lesions in the penetrating branch area were highly associated with hypertension (F = 8.46) and nephropathy (F = 4.75), while those in the subcortex and white matter were associated with aging (F = 6.02) and retinopathy (F = 5.15). In the middle-aged diabetics, the former was associated with hypertension (F = 10.72) and retinopathy (F = 13.32), whereas the latter was associated with retinopathy (F = 20.76). In the elderly diabetics, no significant association was found in either lesions. These results suggest that control of hypertension and prevention of microangiopathy by keeping good control of blood glucose, is essential to prevent asymptomatic lacunae in NIDDM patients.

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With the increment of the aged, primary and secondary prevention of cerebrovascular disease in the Japanese diabetics are crucial problems. Early detection of asymptomatic infarction, not rare in diabetics, is important in the view of cost benefits. Little is known about the development and progression of asymptomatic infarction. We investigated the number of lacuna during a period of 5 years in 51 non-insulin-dependent diabetes mellitus (NIDDM). At the initiation of this study, 22 patients were free from lacuna and another 29 patients had asymptomatic multiple lacunae. In the former patients, no risk factors were different between the 13 patients with still no lacuna and the nine patients with lacuna-developed after 5 years. In the latter patients, the 17 patients with worsening lacunar state had significantly higher systolic blood pressure, and a higher prevalence of macroalbuminuria than the 12 patients with no increment of lacuna. Multiple logistic regression analysis showed that macroalbuminuria after 5 years was the only contributing factor to the increased lacuna. Therefore, in the NIDDM, macroalbuminuria induced an increase of lacuna in magnetic resonance imaging, although numbers of cases were relatively small. Prevention of the development of macroalbuminuria are essential to avoid the progression of asymptomatic lacuna.
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Asymptomatic multiple lacunae in diabetics and non-diabetics detected by brain magnetic resonance imaging

Abstract

Diabetes mellitus and cerebral vascular disease

J. Jpn. Diabetes Soc.

Diabetes and cardiovascular disease. The Framingham study

J. Am. Med. Assoc.

Mortality from coronary heart disease and stroke in relation to degree of glycaemia: the White-hall study

Br. Med. J.

The impact of glucose intolerance on stroke incidence in a 22-year follow up study of the general population, the Hisayama study

J. Jpn. Diabetes Soc.

Glucose intolerance and 22-year stroke incidence: The Honolulu heart program

Stroke

Association of HbA1c with prevalent cardiovascular disease in the original cohort of the Framingham Heart Study

Diabetes

Risk factor for cerebrovascular disease in diabetes mellitus — Effect of blood glucose control

Japanese journal of Stroke

Effects of long-term control of blood glucose and blood pressure on the incidence of stroke in diabetes mellitus

Nuclear magnetic resonance image white matter lesions and risk factors for stroke in normal individuals

Stroke

A clinical study of asymptomatic multiple lacunes in non-insulin dependent diabetics detected by brain magnetic resonance imaging

J. Jpn. Diabetes Soc.

Silent brain infarction in patients with first-ever stroke: a community based study in Umbria, Italy

Stroke

Association of HbA_1c with prevalent cardiovascular disease in the original cohort of the Framingham Heart Study