Laterality of deep white matter hyperintensities correlates with basilar artery bending and vertebral artery dominance

Laszlo Szalontai, Zsofia Jokkel, Tamas Horvath, Bianka Forgo, Ildiko Kalina, Pal Maurovich-Horvat, Philip L. Auyang, M. Mujeeb Zubair, Zsolt Garami, David Laszlo Tarnoki, Adam Domonkos Tarnoki

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Aim To investigate whether vertebrobasilar geometry contributes to the presence, severity, and laterality of white matter hyperintensities (WMH). Methods We retrospectively reviewed 290 cerebral scans of patients who underwent time-of-flight and fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) between 2017 and 2018. WMH were counted, localized, and grouped according to laterality on the FLAIR sequence. A 3D mesh of the posterior circulation was reconstructed (with ITK SNAP software) and the morphology of the vertebrobasilar system analyzed with an in-house software written in Python. Results Patients were assigned into a group with WMH (n = 204) and a group without WMH (n = 86). The severity of WMH burden was mainly affected by age and hypertension, while the localization of the WMH (or laterality) was mainly affected by the vertebrobasilar system morphology. Basilar artery morphology only affected the parietooccipital region significantly if both posterior communicating arteries were hypoplastic or absent. The dominant vertebral artery and basilar artery curve had an opposite directional relationship. Conclusions An unequal vertebral artery flow is an important hemodynamic contributor to basilar bending. Increased basilar artery curvature and increased infratentorial WMH burden may signal inadequate blood flow and predict cerebrovascular events.

Original languageEnglish (US)
Pages (from-to)360-366
Number of pages7
JournalCroatian Medical Journal
Issue number4
StatePublished - Aug 2021

ASJC Scopus subject areas

  • Medicine(all)


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