PERIVENTRICULAR WHITE-MATTER LUCENCY AND CEREBRAL BLOOD-FLOW AUTOREGULATION IN HYPERTENSIVE PATIENTS

The goal of this study was to elucidate the association between the de velopment of periventricular white matter lucency and autoregulation o f cerebral blood flow in hypertensive patients through the arterioveno us oxygen saturation difference method. We studied 51 hypertensive pat ients who had previously suffered from minor strokes (lacunar infarcti on, 43; deep basal minor hemorrhage, 8). Patients were divided into th ree groups based on the findings of periventricular white matter lucen cy. We measured the absolute value of resting cerebral blood flow usin g the argon inhalation method, and stepwise reduction of blood pressur e was obtained with patients on a tilting table. Intracerebral venous blood sampling was accomplished by direct cannulation into the jugular vein up to the jugular bulb. We calculated several cerebral circulato ry parameters, such as cerebrovascular resistance and cerebral oxygen consumption, and also delineated individual autoregulation curves. Cer ebrovascular resistance was significantly greater in patients with sev ere periventricular white matter lucency than in patients without it ( P < .05). Impaired autoregulation was also significantly more prevalen t in patients with more severe periventricular lesions (P < .05). Mult iple regression analysis revealed that the impaired autoregulation was significant and an independent determinant of the severity of such pe riventricular lesions (R = .34, P < .05). In conclusion, our findings indicated that hypertensive patients. with severe periventricular whit e matter lucency were more likely to have impaired autoregulation of c erebral blood flow and suggest that stricter blood pressure control is required in such patients to prevent deterioration of the cerebral mi crocirculation.