Hüseyin Nezih ÖZDEMİR, Emre KUMRAL, Gülcan Neşem BASKAN, Mehmet ORMAN
Turkish Journal of Cerebrovascular Diseases - 2026;32(2):100-107
Background: No prior research has determined whether brainstem white matter hyperintensities (b-WMhs) are associated with first-ever stroke. This study aims to investigate whether b-WMhs can predict first-ever stroke. Methods: This was a retrospective study. Clinical records and magnetic resonance imaging (MRI) scans reviewed to identify patients with and without brainstem white matter hyperintensities (b-WMhs). a total of 180 individuals with b-WMhs and no prior history of stroke, and 205 individuals without b-WMhs, were included. s troke incidence within a three -year observation window was determined retrospectively from medical records and confirmed by neuroimaging, following a merican heart a ssociation/a merican stroke a ssociation ( aha/asa ) guidelines. Predictors of stroke were evaluated using Cox regression analysis. Results: Within the three -year observation window, 37 patients (9.6%) experienced a first -ever stroke, 40.5% in the anterior circulation and 59.5% in the posterior circulation. stroke incidence was significantly higher among patients with b -WMhs (13%) compared with those without (6%) (OR, 2.27; 95% CI, 1.12-4.61; P=0.02). In multivariable Cox regression analysis, stroke occurrence was independently associated with hypertension (hR, 5.39; P<0.001), diabetes mellitus (hR, 4.39; P=0.007), hyperhomocysteinemia (hR, 2.66; P=0.004), and atrial fibrillation (hR, 3.00; P<0.01). The association between b -WMhs and stroke remained significant after adjustment for age, sex, and supratentorial WMhs (s- WMhs), but lost statistical significance when additional vascular risk factors were included. Conclusion: Brainstem white matter hyperintensities are associated with first-ever stroke but are not independent risk factors. Further studies are needed to explore the mechanisms linking b-WMhs to stroke risk.
