Vagus nerve size determined via ultrasonography is associated with white matter lesions in patients with vascular risk factors

Abstract Purpose The cross-sectional area (CSA) of the cervical vagus nerve (VN), as assessed through ultrasonography, might be linked to autonomic nervous system dysfunction. Hypertension is the primary factor associated with cerebral white matter lesions (WMLs), but there is also evidence of a connection with autonomic nervous system dysfunction. However, the associations between WMLs and VN size are unclear. Our objective was to investigate the associations between WMLs and VN size in patients with vascular risk factors. Methods The CSA of the VN was evaluated using carotid ultrasonography in patients with a history of stroke (acute or chronic) and comorbidities ( n = 196, 70.2 ± 12.7 years). Common carotid artery (CCA) intima-media thickness and interadventitial diameter (IAD) were also measured. The severity of the WMLs was assessed by the Fazekas classification and Scheltens’ scale. Results The CSA of the right VN (2.08 ± 0.65 mm 2 ) was significantly greater than that of the CSA of the left VN (1.56 ± 0.44 mm 2 ) ( P < 0.001). Multiple linear regression analyses revealed that older age, hypertension, increased right CCA IAD, and decreased CSA of the right VN (standardized partial regression coefficient β − 0.226; P < 0.001) were independently associated with the severity of WMLs (Scheltens’ scale). A decreased CSA of the left VN was also associated with the severity of WMLs (β = − 0.239; P < 0.001). Conclusion VN size determined via ultrasonography was associated with the severity of WMLs. While these findings do not establish a causal relationship, they suggest that autonomic nervous system dysfunction is involved in the progression of WMLs.