Author response: WMH and long-term outcomes in ischemic stroke: A systematic review and meta-analysis

We thank Dr. Gupta for the interest in our article1 and for raising important issues about alternative causes of white matter hyperintensities (WMH) other than small vessel disease (SVD). Indeed, migraine, hypertensive encephalopathy, eclampsia, and therapy with immunomodulatory agents may cause temporary WMH lesions. Yet, the prevalence of WMH lesions in the general population increases substantially with age because of the increasing underlying burden of SVD.2,3 In our article, we refer to WMH in a specific population of patients with ischemic stroke. Given the relatively old age and the high burden of vascular risk factors of this population, we believe that most WMH lesions in the original studies entered our meta-analysis to represent manifestations of SVD. © American Academy of Neurology.