Search

Resume Les anevrismes intracrâniens (AIC) se definissent par une hernie acquise de la paroi arterielle survenant preferentiellement a une bifurcation arterielle avec une predilection topographique caracteristique au niveau des vaisseaux de la base du crâne. La detection fortuite en scanner ou IRM d’un AIC est une situation frequente, ces examens etant de plus en plus pratiques. Les facteurs de risque modifiables de rupture d’AIC sont bien definis, et les antecedents familiaux d’AIC constituent le principal facteur de risque pour la presence d’AIC. De nombreuses affections hereditaires sont associees a la formation d’AIC, mais ces syndromes representent moins de 1 % de l’ensemble des AIC. Aucun test diagnostique base sur la genetique n’est actuellement disponible pour identifier les mutations et les patients qui presentent un risque plus eleve de developper des AIC. La detection de ces mutations permettrait une meilleure comprehension des voies moleculaires impliquees dans la formation et la rupture des AIC ainsi que le developpement de therapies ciblees.

Purpose New multiple sclerosis (MS) disease-modifying therapies (DMTs), which exert beneficial effects through prevention of relapse, limitation of disability progression, and improvement of patients’ quality of life, have recently emerged. Nonetheless, these DMTs are not without associated complications (severe adverse events like. progressive multifocal leukoencephalopathy). Patient follow-up requires regular clinical evaluations and close monitoring with magnetic resonance imaging (MRI). Detection of new T2 lesions and potential brain atrophy measurements contribute to the evaluation of treatment effectiveness. Current MRI protocols for MS recommend the acquisition of an annual gadolinium (Gd) enhanced MRI, resulting in administration of high volume of contrast agents over time and Gd accumulation in the brain. Methods A consensus report was established by neuroradiologists and neurologists from the French Observatory of MS, which aimed at reducing the number of Gd injections required during MS patient follow-up. Recommendations The French Observatory of MS recommends the use of macrocyclic Gd enhancement at time of diagnosis, when a new DMT is introduced, at 6-month re-baseline, and when previous scans are unavailable for comparison. Gd administration can be performed as an option in case of relapse or suspicion of intercurrent disease such as progressive multifocal leukoencephalopathy. Other follow-up MRIs do not require contrast enhancement, provided current and previous MRI acquisitions follow the same standardized protocol including 3D FLAIR sequences.

Objectif Plusieurs etudes ont compare le traitement endovasculaire d’un AVC a la phase aigue, par thrombectomie mecanique (TM) seule ou associee a la thrombolyse intraveineuse (TIV). Seule 30 % d’occlusion concernait la terminaison carotidienne, celle-ci etant predictive d’un echec de la fibrinolyse. L’objectif de notre etude etait d’evaluer l’impact de la TIV en effectuant une comparaison des patients traites par thrombectomie mecanique (TM) seule versus associee a la TIV. Materiel et methodes Une analyse retrospective multicentrique a ete effectuee sur des patients presentant une occlusion de la terminaison carotidienne et traites par TM seule ou associee a la TIV. Les donnees demographiques, les facteurs de risques cardiovasculaires, les modalites de traitement, les complications, les resultats techniques et cliniques on ete collectes. Un score de propension a ete utilise afin d’evaluer le score de Rankin modifie (mRs) a 3 mois et le taux d’hemorragie cerebral entre les deux groupes. Resultats Au total, 141 patients consecutifs (40 % traitement associe a la TIV, 60 % par TM seule) ont ete inclus de janvier 2014 a juin 2016. Les donnees demographiques ne differaient pas entre les deux groupes. Le taux de recanalisation TICI 2b/3, le taux d’embole distal et le nombre de passage de dispositif de TM n’etait pas significativement different. Il avait une difference significative entre les deux groupes concernant le temps median entre l’imagerie et la ponction arterielle (97 min versus 75, p = 0,007), le taux d’hemorragie cerebrale (44 % versus 27 %, p = 0,05), mais non en termes d’hemorragie symptomatique (18 % versus 13 %, p = 0,49). L’etude avec le score de propension montrait une tendance a une hemorragie plus frequence en cas de TIV (OR = 2,3, IC95 % : 0,9–5,9, p = 0,09), sans difference concernant le mRs a 3 mois (OR = 1,6, IC95 % : 0,7–3,7, p = 0,29). Conclusion Dans notre etude, la TIV augmente le delai de ponction arterielle et le taux d’hemorragie cerebrale. Cependant, il n’y avait pas de difference en termes d’evolution clinique en cas de TM seule ou associee a la TIV.

Photo-produced singlet oxygen may be deactivated through the production of secondary reactive oxygen species (ROS). The lifespan, nature and the effects of these ROS depend on the local biochemical conditions such as tissue resistance to ROS. Using an in vitro assay involving Rose Bengal as a photosensitizer (1O2 quantum yield of 0.75), we noted that patients showed decreased systemic resistance to 1O2 during ischemic strokes (1O2 quantum yield of 1.83) or silent aneurysms (1O2 quantum yield of 1.15) and increased systemic resistance after subarachnoid hemorrhages (1O2 quantum yield of 0.65) (n = 20 for each) as compared to controls (1O2 quantum yield of 0.9 ± 10%). An inverse correlation (R2 = 0.98) was found with the vitamin D content of serum. This suggests that systemic oxidative changes are induced early during cerebral suffering, but differently according to the cause of brain tissue necrosis.

Summary Background and purpose The electronic reference to access in vivo concentrations (ERETIC) method is a promising technique for absolute concentration quantification by brain proton magnetic resonance spectroscopy (1H-MRS). However, in its usual form, the technique cannot be implemented in most clinical MR scanners. For this reason, we propose a new strategy for transmitting the ERETIC signal before localized spectroscopy acquisition, thereby allowing its use in clinical MR scanners. Methods ERETIC signal acquisition, using a dedicated sequence, was carried out immediately before the MR sequence. This approach was evaluated on phantoms of known metabolite concentrations and in 10 healthy volunteers. The results were then compared with those obtained using the water signal as reference. Results Measurements in vitro showed that the standard deviations measured by the ERETIC method were similar to those using the water-signal reference method. Also, values for metabolite concentrations in vivo were in good agreement with those found in the literature for normal white matter in human brains. Concentrations obtained by ERETIC showed good linear correlation compared with the values obtained by the water-signal reference method. Conclusion Our preliminary study shows that the ERETIC method appears to be a reliable technique that can overcome most of the drawbacks observed with other absolute quantification methods. However, further studies involving larger patient groups are needed to confirm these findings.

Resume Introduction La decouverte fortuite d’une lesion cerebrale asymptomatique en IRM est une situation non rare depuis la diffusion de cette technique comme outil de diagnostic et de recherche clinique. Etat des connaissances La prevalence, evaluee sur des cohortes de volontaires sains participant a des etudes est de 1,7 a 4 p. 100. Les lesions les plus souvent detectees sont des tumeurs intracrâniennes (meningiome, tumeur primitive neuro-epitheliale, kyste arachnoidien, apparente aux tumeurs) et les malformations vasculaires. Les risques evolutifs de ces lesions et les mesures therapeutiques qui peuvent decouler de la decouverte d’un incidentalome meritent d’etre bien connu du medecin. Perspectives Une meilleure connaissance de l’evolution spontanee des lesions de decouverte fortuite permettra d’adapter les modalites de prise en charge a chaque individu. Conclusion Le neurologue est frequemment confronte a la decouverte d’une lesion asymptomatique en IRM. Il doit etre en mesure de rassurer le patient et si besoin d’enclencher une prise en charge specifique.

Resume Objectifs. – L’hypotension intracrânienne spontanee (HIS) est un syndrome rare. Il est generalement du a des fuites spinales de liquide cephalorachidien. Le traitement conservateur est souvent insuffisant. Le blood-patch (BP) au niveau de la localisation de la fuite, effectue des le diagnostic d’HIS pose, a ete propose dans certaines etudes. Le but a ete d’evaluer l’efficacite et la tolerance d’un BP lombaire pour traiter l’HIS. Type d’etude. – Analyse d’une serie de cas. Patients et methodes. – Etude menee chez six patients consecutifs. Le diagnostic d’HIS a ete etabli a partir de signes cliniques et morphologiques (tomodensitometrie et imagerie par resonance magnetique cerebrales). Le BP a ete effectue en position lombaire haute des le diagnostic pose. La procedure pouvait etre repetee au maximum trois fois. Resultats. – La disparition complete des cephalees a ete observee chez cinq des six patients (des le premier BP pour 3 d’entre eux et apres 2 et 3 BP pour les 2 autres) et une amelioration partielle pour une patiente chez qui une large effraction dure-mero-arachnoidienne a ete diagnostiquee par la suite. Aucune complication liee au BP n’a ete constatee. Conclusion. – Une fois le diagnostic d’hypotension intracrânienne pose, une serie de BP lombaires peut etre proposee chez ces patients avec un espoir raisonnable de guerison.

International audience; BACKGROUND AND PURPOSE:Some patients with large or recurrent aneurysms may be at increased risk of recurrence postcoiling. The Patients Prone to Recurrence after Endovascular Treatment (PRET) trial was designed to assess whether hydrogel coils were superior to platinum coils in these high-risk patients. This article reports periprocedural safety and operator-assessed angiographic results from the PRET trial.MATERIALS AND METHODS:PRET was a pragmatic, multicenter, randomized controlled trial. Patients had ≥10-mm aneurysms (PRET-1) or a major recurrence after coiling of an aneurysm of any size (PRET-2). Patients were randomly allocated to hydrogel or control arms (any platinum coil) by using concealed allocation with minimization. Assist devices could be used as clinically required. Aneurysms could be unruptured or recently ruptured. Analyses were on an intent-to-treat basis.RESULTS:Four hundred forty-seven patients were recruited (250 PRET-1; 197 PRET-2). Aneurysms were recently ruptured in 29% of PRET-1 and 4% of PRET-2 patients. Aneurysms were ≥10 mm in all PRET-1 and in 50% of PRET-2 patients. They were wide-neck (≥4 mm) in 70% and in the posterior circulation in 24% of patients. Stents were used in 28% of patients (35% in PRET-2). Coiling was successful in 98%. Adverse events occurred in 28 patients with hydrogel and 23 with platinum coils. Mortality (n=2, unrelated to treatment) and morbidity (defined as mRS>2 at 1 month) occurred in 25 patients (5.6%; 12 hydrogel, 13 platinum), related to treatment in 10 (4 hydrogel; 6 platinum) (or 2.3% of 444 treated patients). No difference was seen between hydrogel and platinum for any of the indices used to assess safety up to at least 30 days after treatment. At 1 month, 95% of patients were home with a good outcome (mRS≤2 or unchanged). Operator-assessed angiographic outcomes were satisfactory (complete occlusion or residual neck) in 339 of 447 or 76.4% of patients, with no significant difference between groups.CONCLUSIONS:Endovascular treatment of large and recurrent aneurysms can be performed safely with platinum or hydrogel coils.

Background Neurologic involvement occurs in approximately 25% of patients with primary Sjogren's syndrome. Manifestations are diverse and can affect the entire neuroaxis. Central nervous system dysfunction involves the brain as well as the spinal cord and may recur over time. Due to a variety of presentations, Sjogren's syndrome with neurologic involvement may be difficult to diagnose. Methods We report 4 cases of patients with primary Sjogren's syndrome who presented with atypical neurologic manifestations. Results The first case describes a patient with a pseudotumoral lesion. The second patient was a 54-year-old woman suffering from a multiple mononeuropathy. The third case describes a 66-year-old man whose primary Sjogren's syndrome presented as progressive multiple sclerosis, and the fourth case reports a 57-year-old woman patient suffering from myelitis along with progressive cognitive disorders. Conclusions Neurologic impairment in Sjogren's syndrome is probably underestimated and the diagnosis is often delayed. Primary Sjogren's syndrome should be suspected in patients presenting with atypical clinical and radiologic neurologic manifestations.

Toxocariasis is usually responsible for visceral larva migrans syndroms. Nervous system involvement is a rare complication. In this report, we describe one case of meningoencephalitis due to Toxocara canis in a 73-year-old man presenting with mental confusion. The diagnosis of cerebral toxocariasis was confirmed by immunodiagnosis in both serum and cerebro-spinal fluid. Cerebral toxocariasis may be suspected in patients presenting with some neurological patterns including: confusion, meningitis, meningo-encephalitis, meningo-myelitis, when the etiological assessment remains negative and the environmental context is favourable. Finding evidence of specific antibodies in both cerebro spinal fluid and serum is mandatory for the diagnosis. The main clinical features concerning cerebral toxocariasis, diagnostic tools, and therapeutic measures are discussed.

Vertebrovertebral Arteriovenous Fistula (V.V.A.V.F.) is a relatively rare entity. It may be an incidental finding or be detected in patients presenting with pulsatile tinnitus, cervical bruit, or vertebro-basilar insufficiency. It can be spontaneous but it most frequently is post-traumatic in etiology. The authors report 8 patients, 4 women and 4 men aged between 20 to 77 years, with 4 post-traumatic V.V.A.V.F. and 4 spontaneous V.V.A.V.F. that were seen over a 15 year period. Imaging work-up included Doppler US (n=4), MRI 9n=3) and angiography (n=8). Seven of 8 patients were treated successfully using an endovascular technique (5 with balloon occlusion, 1 with coil embolization and 1 using a mechanical maneuver), without complication or recurrence, except in one case. We compare our results with published reports from the literature and review the underlying pathology and management strategies of V.V.A.V.F.

To report four cases of patient with an acute ischemic event as a presenting symptom of a berry aneurysm.One male and three female (aged range 38 to 65 years) patients were admitted for acute stroke. The neuroradiologic finding disclosed aneurysm thrombosis, inferior to twenty five millimetres in three cases. Lumbar puncture was done in one case and showed subarachnoid haemorrage.We will discuss the hypothesis leading to the mechanism of aneurysm thrombosis. Two theories will be presented: "hemodynamic" and "parietal" modifications. We will propose a management protocol for these patients with atypical presentation of intracranial aneurysms given the potential risk of rupture.The natural history of intracranial aneurysms is still not fully understood. Nevertheless, aneurym thrombosis may occur and lead to ischemic stroke.

To report our recent experience in transarterial embolisation of dural arteriovenous malformations (DAVM) using a new liquid embolic agent, Onyx18.6 patients were enrolled in this series. Clinical presentation was separated into 2 groups: aggressive (n=2), non aggressive (n=4). The DAVM was located at the superior sagittal sinus (n=1), at the transverse sinus (n=2), at the condylian canal (n=1), in the lesser sphenoid wing region (n=1), and in the tentorium region (n=1). The DAVM drained directly into a condylian or a cortical vein for three patients and into a venous sinus with cortical venous reflux for the three others. In this latter situation, the sinus was anatomically excluded from the normal brain venous drainage.A full brain angiogram including both internal carotid arteries, both external carotid arteries and ipsilateral vertebral artery, was performed before and after each treatment. The feeder chosen after a selective catheterisation for Onyx18 injection was always meningeal. Each treatment consisted of a single Onyx injection after one unique feeder catheterisation. Complete anatomical exclusion of the DAVM was achieved and demonstrated by the post treatment angiogram in all cases. There was no clinical complication after the treatment.Onyx18 used is a safe treatment for DAVMs. When its injection is performed in optimal conditions, it fills the total DAVM and its drainage vein or sinus after a single arterial feeder catheterisation.

Incidental findings on brain MRI are not rare since the development of MRI as a diagnostic and clinical research tool.Prevalence of cerebral incidental finding, based on research volunteers participating in studies, is estimated from 1.7 to 4 percent. The most frequently detected lesions are intracranial tumors (meningioma, arachnoid cysts, neuro-epithelial tumor) and vascular malformations.A better knowledge of the spontaneous outcome of incidental findings would allow adequate management of these patients.Clinicians should be aware of the outcome of incidental findings, to reassure patients or trigger a work-up if necessary.

Magnetic resonance angiography (MRA) is a very valuable tool in the routine evaluation of patients with stroke syndrome. It provides powerful noninvasive imaging of the cervical and intracranial vessels allowing the detection and the diagnosis of vascular anomalies. MRA usefully supplements, during the same examination, the analysis by MRI of the cerebral parenchyma. We will describe the indications of the various techniques (MRA with and without injection of contrast media) and show the value, artifacts and limitations of MRA in atherosclerotic stenosis or occlusive disease and in arterial dissections. This noninvasive vascular assessment will depend on the initial therapeutic orientation. Within the framework of the hemorrhagic stroke, we will discuss the role and the interest of dynamic MR angiography in the tracking and control of intracranial aneurysms and also the contribution of this newer sequences with gadolinium injection in the detection of cerebral vascular malformations.

Spontaneous intracranial hypotension (SIH) is a rare syndrome. It is due most often to a spinal meningeal leak. Symptoms due to SIH are often difficult to treat and epidural blood-patch (BP) has been proposed. The aim was to evaluate the effects and the problems associated with lumbar blood-patch to treat SIH.Case series.The diagnosis of SIH was made in six consecutive patients on clinical signs and radiological findings (CT-scan and MRI). A lumbar BP (L1-L2 level) was performed as soon as possible after diagnosis. A maximum of three procedures was allowed in case of failure of the initial BP.BP was effective and well tolerated for five patients (3 immediately after BP, 2 others patients needed 2 and 3 BP). In one patient, an incomplete response was observed and was related to a large CFS leak diagnosed by CT-myelogram.When the diagnosis of spontaneous intracranial hypotension is confirmed, a repeated blood patch lumbar procedure can be efficient to treat these patients.

Dural fistulas are acquired arteriovenous shunts, accounting for 10-15p.cent of cerebrovascular malformations. Symptoms are commonly tinnitus or intracranial hemorrhage. Rarely, patients with dural fistulas can present with rapid cognitive impairment. We report two women with rapidly evolving dementia. Cerebral angiography revealed dural arteriovenous fistula, with retrograde drainage into cortical veins, related to thrombosis of both transverse sinuses. Intra-arterial and intra-venous endovascular approaches failed to cure the fistula. Venous embolization via a transcranial approach was required to occlude the fistula, leading to resolution of the symptoms. Dural arteriovenous fistulas may lead to dementia with diffuse white matter changes related to venous ischemia, and must be considered as a reversible cause of vascular dementia. A transcranial approach for venous embolization is sometimes required.

The management of Brain Arteriovenous Malformations continues to be challenged by a lack of understanding and control of pathophysiological processes implied in the clinical symptoms. New data from functional MRI with diffusion-weighted, perfusion-weighted and neuronal activation highlight abnormal brain areas near or remote to the AVM nidus. Moreover, these techniques are able to show hemodynamic and neuronal adaptative phenomena involved in brain plasticity. They reflect the instantaneous hemodynamic brain conditions that may help to correlate the clinical symptoms with the anatomical and functional substratum and to influence any invasive therapy.

To point out the importance of both MRI and MR angiography for the diagnosis and follow-up of moyamoya disease.We report seven cases. MRI was performed in the initial phase in three cases. MR angiography without conventional angiography led to the diagnosis in one case. Conventional angiography was performed in six cases. Follow-up MRI and MR angiography were obtained in two.The initial MRI revealed ischemic lesions in the sylvian territory in two cases, and a cerebral malformation in one, after-effect lesions in two, and cerebral atrophy and ventricular dilatation in one. Conventional angiography provided the diagnosis of moyamoya disease in all cases, associated with cerebral arteriovenous malformation in two.MRI and MRA should be performed for the diagnosis and follow-up of moyamoya disease.

Downward herniation of the cerebellar tonsils through the foramen magnum (Chiari I malformation) is usually revealed by head and neck pain, often associated with brain-stem or spinal cord disturbances. Syncopes are rarely reported and may be difficult to link to their cause when they occur alone. We report two cases with brief and repetitive syncopes revealing a Chiari I malformation. These manifestations may be attributed to transient compression of brain stem or vascular structures at the craniocervical junction, triggered by intracranial pressure increase, as they disappear after posterior fossa decompression.

The occurrence of stroke after the post-operative period of cardiac transplantation is a rare event, and the role of the cardiac transplant in these patients, who often have various vascular risk factors, is unclear. We reviewed the clinical records of 303 consecutive patients with orthotopic cardiac transplantation performed from March 1985 to December 1996 and selected those who developed a stroke over the first 2 months postoperatively, in order to evaluate the frequency and the mechanisms of late cerebrovascular complications. Four patients had presented cerebral infarct and two intracranial hemorrhage. The overall risk of late cerebrovascular complications was 2.6p.100 at 5 years. Ischemic stroke was related to cardiac embolus in one patient, lacunar infarction in another, and was of undetermined etiology in two cases. In addition to vascular risk factors prior to transplantation and the development of intracardiac thrombus, immunosuppressive therapy, the surgical procedure and cardiac rejection may play a role in the occurrence of stroke in such patients.

We report a case of venous angioma revealed by seizure after a non hemorrhagic venous infarct. The initial neuroradiological work-up with CT scan, angiography and brain MRI evidenced the venous infarction with abnormal contrast uptake. The control MRI 3 months later showed clear involution of the venous infarct. Non-hemorrhagic venous infarction on venous angiomas are exceptional. Only 2 cases have been reported in the literature. Impaired venous drainage could be implicated.

From 1977 to 1996, 49 direct carotido-cavernous fistulae were studied among the sixty some cases diagnosed over these 20 years. Five were caused by spontaneous rupture of an intracavernous aneurysm and the others were caused by trauma.The clinical presentation in 37 patients was exophthalmia with pulsating conjunctival hyperhemia and vascular murmur. Some cases had a neurological syndrome suggesting cavernous involvement. A bilateral presentation was observed in 2 cases. One patient had no ophthalmologic syndrome but had a vascular murmur. Prior to 1982, all patients were treated and cured by occlusion of the internal carotid after direct access via the neck using a 3 F Fogarty catheter. Since 1982, patients have been treated with the detachable balloon technique. The carotid was preserved in 16 cases. In one case, secondary thrombosis occurred due to major dissection. In one case, the size of the breach was too small for the balloon so a coil was used. In one other case, insertion of the guide wire and catheter was sufficient to occlude the fistula. There was one death during treatment due to fistula rupture and one partially regressive right hemiplegia which could not be explained. This patient also developed left hemiplegia two years later, again with no explaining cause. Cure was achieved in the other patients without sequellae.Direct carotido-cavernous fistulae due to rupture of an aneurysm or trauma are uncommon. When flow through the breach is minimal, vascular treatment may not be necessary unless clinical signs appear since this type of fistula heals spontaneously. In other cases, an endovascular balloon procedure is indicated. There are few complications. Embolization with coils or other devices should only be used in selected cases when the breach is too small for the balloon.

2082 Background: In gliomas, relationship between radiological characteristics and several biomarkers was the subject of numerous publications. Mutations in the isocitrate dehydrogenase 1 (IDH1) gene have been identified recently to play a key role in these tumors occuring in up to 75% of low-grade diffuse (WHO grade II) and anaplastic (WHO grade III) astrocytic, oligodendroglial and mixed oligodendroglial neoplasms. However, the correlation with magnetic resonance imaging (MRI) features has been little studied. Methods: Patients treated for WHO grade II and III oligodendroglial tumors between 2005 and 2011 were retrospectively identified. Each case has been reviewed by the same neuropathologist. IDH1 and IDH2 mutations were available. Preoperative MRI, including T1 weighted, T2 weighted, T1 contrast enhanced, FLAIR, T2* weighted, diffusion weighted (ADC ratio), perfusion weighted (CBV ratio) and MR spectroscopy, were analyzed by two radiologists blinded from molecular data. Logistic regression analysis and Fisher’s test were used to develop predictive models of genetic profile from imaging. Results: Sixty eight patients, WHO grade II (n= 37) and grade III (n=31) patients were identified. Mean age at diagnosis was 46 years; ratio male/female was 40/28. IDH1 mutations were identified in 42 patients (62 %), IDH2 in 4 patients (6 %). Analysis of tumor location, size, borders, morphological aspect, and signal did not shown any significant difference between IDH1 mutated group and IDH1 non mutated group neither in grade II nor in grade III oligodendroglial tumors. In the same way, MR spectroscopy (Choline/NAA ratio and detection of lipid and lactate) was not relevant to discern the two groups. As well, ADC ratio (1,5 versus 1,4; p=0,35) and CBV ratio (3,4 versus 4,2; p= 0,46) did not reveal any difference between mutated group and non mutated group. Conclusions: In our study, IDH1 mutations were not correlated with MRI features available during routine MRI. Nevertheless, recent studies suggest the ability of MR spectroscopy to detect 2-hydroxyglutarate as an MRI marker of IDH1 mutated tumors, which encourage carrying on research in molecular imaging.

The association between aldosterone synthase (CYP11B2) gene polymorphism and white matter hyperintensities seen on cerebral MRI was studied in a population-based sample of 829 individuals aged 63 to 75 years. The T allele was associated with the risk of severe white matter hyperintensities. Compared with the CC genotype, the adjusted OR for severe white matter hyperintensities was 4.61 (95% CI, 1.46 to 14.55) for the TT genotype and 2.45 (95% CI, 0.81 to 7.46) for the TC genotype in men. This association was independent of hypertension.