BACKGROUND AND PURPOSE: Blood-brain barrier dysfunction may be an early phenomenon in the development of the small vessel disease, which underlies white matter lesions. Because vitamin B12 plays a role in maintaining the integrity of the blood-brain barrier, we studied serum vitamin B12 level in relation to such lesions. METHODS: In 124 patients with first lacunar stroke, we measured serum vitamin B12 level and rated the degree of white matter lesions on MRI. RESULTS: Mean vitamin B12 level was 202 pmol/L (SD, 68.9). Thirty-nine patients (31.5%) had a vitamin B12 level less than the lower reference value of 150 pmol/L. Lower vitamin B12 level was (statistically significant) associated with more severe periventricular white matter lesions (odds ratio/100 pmol/L decrease, 1.773; 95% CI, 1.001-3.003), but not with deep white matter lesions (odds ratio/100 pmol/L decrease, 1.441; 95% CI, 0.881-2.358; ordered multivariate regression analysis). CONCLUSIONS: More severe periventricular white matter lesions in lacunar stroke patients relate to lower vitamin B12 levels. A possible causal relationship should now be studied prospectively.
BACKGROUND AND PURPOSE: Blood-brain barrier dysfunction may be an early phenomenon in the development of the small vessel disease, which underlies white matter lesions. Because vitamin B12 plays a role in maintaining the integrity of the blood-brain barrier, we studied serum vitamin B12 level in relation to such lesions. METHODS: In 124 patients with first lacunar stroke, we measured serum vitamin B12 level and rated the degree of white matter lesions on MRI. RESULTS: Mean vitamin B12 level was 202 pmol/L (SD, 68.9). Thirty-nine patients (31.5%) had a vitamin B12 level less than the lower reference value of 150 pmol/L. Lower vitamin B12 level was (statistically significant) associated with more severe periventricular white matter lesions (odds ratio/100 pmol/L decrease, 1.773; 95% CI, 1.001-3.003), but not with deep white matter lesions (odds ratio/100 pmol/L decrease, 1.441; 95% CI, 0.881-2.358; ordered multivariate regression analysis). CONCLUSIONS: More severe periventricular white matter lesions in lacunar strokepatients relate to lower vitamin B12 levels. A possible causal relationship should now be studied prospectively.
Authors: Ioana Cotlarciuc; Rainer Malik; Elizabeth G Holliday; Kourosh R Ahmadi; Guillaume Paré; Bruce M Psaty; Myriam Fornage; Nazeeha Hasan; Paul E Rinne; M Arfan Ikram; Hugh S Markus; Jonathan Rosand; Braxton D Mitchell; Steven J Kittner; James F Meschia; Joyce B J van Meurs; Andre G Uitterlinden; Bradford B Worrall; Martin Dichgans; Pankaj Sharma Journal: Stroke Date: 2014-05-20 Impact factor: 7.914