Homocysteine is related to enlarged perivascular spaces in the brainstem in patients with isolated pontine infarction

Yunting Fu; Wenwei Yun; Zhixiang Zhang; Yi Ma; Lulu Xiao; Min Zhang; Wusheng Zhu

doi:10.1186/s12883-022-02744-9

Homocysteine is related to enlarged perivascular spaces in the brainstem in patients with isolated pontine infarction

BMC Neurol. 2022 Aug 11;22(1):296. doi: 10.1186/s12883-022-02744-9.

Authors

Yunting Fu¹, Wenwei Yun¹, Zhixiang Zhang¹, Yi Ma², Lulu Xiao³, Min Zhang⁴, Wusheng Zhu^{5

6}

Affiliations

¹ Department of Neurology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, No.29, Xinglong Lane, Changzhou, Jiangsu Province, 213004, China.
² Department of Radiology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, China.
³ Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.
⁴ Department of Neurology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, No.29, Xinglong Lane, Changzhou, Jiangsu Province, 213004, China. zhangmin0411@njmu.edu.cn.
⁵ Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China. zwsemail@sina.com.
⁶ Department of Neurology, Jinling Clinical Medical College of Nanjing Medical University, No.305, East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China. zwsemail@sina.com.

Abstract

Background: Homocysteine is correlated with several imaging features of cerebral small vessel disease including white matter hyperintensities, lacunes, and enlarged perivascular spaces (EPVS) in the basal ganglia. However, little is known about EPVS in the brainstem. This study aimed to investigate the correlation between serum total homocysteine (tHcy) and EPVS in the brainstem in patients with acute isolated pontine infarction.

Methods: Consecutive patients with isolated pontine infarction were retrospectively enrolled. Clinical characteristics and laboratory tests including tHcy were recorded. Imaging markers of cerebral small vessel disease including EPVS in the basal ganglia (BG-EPVS), EPVS in the centrum semiovale, and EPVS in the midbrain or pons (brainstem-EPVS) were assessed using conventional magnetic resonance imaging. The relation between tHcy and EPVS of different parts in the brain was analyzed using univariate and multivariate regression model.

Results: A total of 227 patients were included (mean age 67.10 ± 9.38 years, male sex 58.6%). The frequencies of brainstem-EPVS and moderate to severe BG-EPVS accounted for 40.1% (91/227) and 40.5% (92/227) respectively. After controlling for confounding factors, multivariate logistic regression analyses showed that tHcy was an independent risk factor for both moderate to severe BG-EPVS (P = 0.003, P for trend < 0.001) and the presence of brainstem-EPVS (P < 0.001, P for trend < 0.001) in a dose-dependent manner. Furthermore, multivariate linear regression model indicated that the presence of brainstem-EPVS (β = 0.264, 95% confidence interval = 0.143-0.402, P < 0.001) and the severity of BG-EPVS (β = 0.162, 95% confidence interval = 0.024-0.197, P = 0.013) were positively associated with serum tHcy.

Conclusions: Serum tHcy is correlated with brainstem-EPVS and BG-EPVS dose-dependently. This study may support a contributing role for homocysteine in the pathophysiology of EPVS in the brainstem and the basal ganglia.

Keywords: Cerebral small vessel disease; Enlarged perivascular spaces; Homocysteine; Isolated pontine infarction.

MeSH terms

Aged
Brain Stem
Cerebral Small Vessel Diseases* / pathology
Homocysteine
Humans
Infarction
Magnetic Resonance Imaging
Male
Middle Aged
Nervous System Malformations*
Retrospective Studies

Substances

Homocysteine