Periodic Limb Movements During Sleep and White Matter MRI Hyperintensity in Minor Stroke or TIA

The study by Boulos et al. reports, in a relatively small group of patients with first-ever minor ischemic stroke or transient ischemic attack (TIA), that the amount of periodic leg movements during sleep (PLMS) is positively associated with the volume of white matter hyperintensity (WMH) at MRI.1 This finding is in line with the increasing amount of data indicating a possible role for PLMS in the risk for cardio- and cerebrovascular diseases.2 This interesting paper stimulated us in replicating this analysis in a larger series of patients recruited in the context of a multicenter, international prospective polysomnographic (PSG) study in patients with ischemic stroke and TIA (SAS-CARE).3 We selected, from the whole group of 255 patients enrolled (the relative complete set of data will be published independently), those with clinical features comparable to those of the patients reported by Boulos et al.1; in this way, we were able to collect data from a total of 68 patients (56 males and 13 female, mean age 59.8 years, range 29.8–78.6 years). The inclusion criteria were: no previous clinical acute cerebrovascular event, unilateral symptoms, diagnosis of TIA or ischemic stroke, NIH Stroke Scale (NIHSS) ranging between 0 and 3 at discharge from hospital. All subjects underwent a full-night PSG recording and a brain MRI within 1 week from the event, followed by the quantification of the volume of the stroke and of WMH over the nonaffected hemisphere. An additional PSG recording was available for 67 out of these 68 patients, obtained approximately 3 months after the acute event.