الفهرس 
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Abstract
Summery
More than half of all elderly individuals have some
degree of white matter lesions (WML) on magnetic
resonance imaging (MRI). The exact pathophysiology
underlying these morphological changes and their clinical
relevance is still unclear (Enzinger et al., 2007).
This advances in imaging technique of the brain
revealed a term called white matter hyperintensity (WMH)
or white matter changes (WMC). White matter
hyperintensity is a common radiographic finding in the
aging population and a potent risk factor for symptomatic
cerebrovascular disease. It is unclear whether WMH
represents a single or multiple biological processes (Rost et
al., 2010).
White matter lesions on MRI are seen as more or less
confluent areas that are bilaterally and symmetrically sited
in the hemispheric white matter and that appear
hyperintense on T2-weighted and fluid-attenuated inversion
recovery images (Pantoni, 2010).
Small vessel disease (SVD), or microangiopathy, of
the cerebral white and central grey matter is a frequent
cause of white matter lesions causing cognitive impairment
Summery
162
and dementia in old age. It is a major, and possibly the
most frequent subtype of vascular cognitive impairment
(Schmidtke and Hull,2005).
Another an important cause of vascular white matter
lesion is border zone infarction. The term border zone
infarction has traditionally been used for ischaemic stroke
caused by hypoperfusion and not by emboli or by local
vasculopathy as in lipohyalinosis (Klijn and Kappelle,
2010).
A total of 63 patients, admitted to Ain Shams
University Hospital during the period from January 2013 to
June 2014 with a diagnosis of acute ischemic cerebral
white matter changes, were recruited to this study. Among
which, 3 patients were dropped out due to incomplete data.
A cross sectional (observational) study was done for 60
patients.
All of the patients subjected to full clinical history,
clinical assessment with (NIHSS) and barthel index,
laboratory investigations, ECG, transthoracic
echocardiography, carotid duplex MRI brain (including
T2*, T1, T2, FLAIR, DWI and SWI) and MR perfusion
with TTP.
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163
At the first, we divide the patients into 2 groups
according to the finding of the carotid duplex (patient with
carotid stenosis 70% or more and patient with carotid
stenosis less than 70%). Then we compare the clinical data
(age, NIHSS scale, Barthel index, history of syncopal
attacks, history of limb shaking and history of retinal
claudication), the laboratory data (HbA1C, CRP and lipid
profile) and the MRI data (TTP of MRI perfusion, pattern
of lesion in diffusion MRI, pattern of lesion in FLAIR,
FLAIR symmetry and grading of microbleeds in SWI)
between the two groups.
Second, we compare the perfusion finding (TTP
difference of the 4 regions of interest mentioned before)
with clinical data (history of syncopal attacks, limb shaking
and retinal claudication) and other radiological data.
Third, we divide the patient into 2groups according
to MRA (patients with intracranial stenosis and patients
without intracranial stenosis). We correlate the MRA
finding with perfusion parameters, pattern of lesion in
diffusion, pattern of lesion in FLAIR, FLAIR symmetry
and grading of microbleeds in SWI.
We found significant relationship between significant
carotid stenosis and CRP level. CRP level was statistically
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164
significant high in group of patient without significant
carotid stenosis.
We also found highly statistically significant relation
between extra cranial stenosis and perfusion of different
ipsilateral regions of interest of brain tissue when
comparing with contralateral side.
Pattern of lesion of recent ischemic lesion in Diffusion
MRI was significantly different in patients with and
without extra cranial stenosis.
The patients with extra cranial carotid stenosis tend to
have significant asymmetrical pattern of WMC in FLAIR
MRI.
Patients with extra cranial carotid stenosis less than
70% had significant high score regarding grading of
microbleeds in relation to patients with extra cranial carotid
stenosis 70%or more.
Our results also revealed statistically significant
relation between cerebral perfusion parameters of both
anterior and posterior wedge shaped areas (measured by
TTP differences between both cerebral hemispheres) and
pattern of lesions in DWI MRI.
TTP difference between ipsilateral and contralateral
side of recent ischemic insult was highly statistically
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165
delayed in patients with asymmetrical WMC in FLAIR
MRI.
Also patients with intracranial stenosis had highly
statistically significant delayed TTP difference in all ROIs.
The correlation between presence of intracranial
stenosis and pattern of WMC symmetry in FLAIR MRI
was highly statistically significant. Patients with
intracranial arterial stenosis had high tendency to have
asymmetrical lesions.
Finally our study revealed non significant relation
between the following findings:
NIHSS, Barthel index, history of syncopal attacks,
limb shaking and retinal claudication, HbA1C and
lipid profile versus presence of significant carotid
stenosis (70%or more).
Pattern of lesion in FLAIR MRI versus significant
carotid stenosis and TTP difference of all selected
ROIs.
TTP difference of all selected ROIs versus grading of
microbleeds in SWI MRI.
Presence of intracranial stenosis in MRA versus
pattern of lesions in Diffusion and FLAIR MRI and
grading of microbleeds in SWI MRI.