Is Small Vessel Ischemic Disease Hereditary
Lacunar infarcts and white matter hyperintensities on magnetic resonance imaging are the hallmarks of cerebrovascular small vessel disease, which affects approximately 5% of the population. There have been several monogenic genetic disorders that cause cerebral small artery disease and stroke that have been discovered.
How Can Cerebral Small Vessel Disease Be Treated Or Prevented
Experts are still trying to figure out the answers to this question, and research into the prevention of cerebral SVD is ongoing.
Since progression of cerebral SVD seems often associated with clinical problems, experts are also trying to determine how we might prevent, or delay, the progression of SVD in older adults.
Generally, experts recommend that clinicians consider treating any underlying risk factors. In most cases, this means detecting and treating any traditional risk factors for stroke.
To date, studies of hypertension treatment to prevent the progression of white matter changes have shown mixed results. It appears that treating high blood pressure can slow the progression of brain changes in some people. But such treatment may be less effective in people who are older than 80, or who already have severe cerebral SVD.
In other words, your best bet for preventing or slowing down cerebral SVD may be to properly treat high blood pressure and other risk factors before you are 80, or otherwise have significant SVD.
Furthermore, experts dont yet agree on how low to go, when it comes to optimal blood pressure for an older person with cerebral small vessel disease.
For now, to prevent the occurrence or progression of cerebral small vessel disease, its reasonable to start by observing the hypertension guidelines considered reasonable for most older adults: treat to a target of systolic blood pressure less than 150mm/Hg.
What Is Microvascular Ischemic Disease
Doctors use the term microvascular ischemic disease to refer to changes that occur in the walls of the small blood vessels of an organ.
Conditions that affect these blood vessels can damage white matter in the brain. White matter contains nerve fibers that send signals between different parts of the brain.
Microvascular ischemic brain disease is a silent disease, which means that most people who have it do not experience noticeable symptoms.
However, doctors can look for signs of microvascular ischemic disease using brain MRI scans.
Microvascular ischemic disease commonly affects older adults. Without treatment, it can
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Should I Worry About My Results
If the appearance of small ischemic areas comes on with no other healthy conditions, doctors may not worry and advise you to live a healthy lifestyle. It is important to quit smoking, eat healthy, and get plenty of exercise. Obesity can contribute to other diseases that can lead to any kind of vascular disease.
In other instances, where there is a health condition along with more areas in the brain that appear to be chronic, your doctor will most likely place you on aggressive blood pressure protocols to reduce the risk of stroke. You will also need to get other health conditions stable such as lowering cholesterol, keeping blood sugar in normal ranges, and losing excess weight.
Genetic And Inflammatory Mechanisms
Evidence continues to accumulate that inflammation and genetic factors have important roles in the development of atherosclerosis and, specifically, in stroke. According to the current paradigm, atherosclerosis is not a bland cholesterol storage disease, as previously thought, but a dynamic, chronic, inflammatory condition caused by a response to endothelial injury.
Traditional risk factors, such as oxidized low-density lipoprotein cholesterol and smoking, contribute to this injury. It has been suggested, however, that infections may also contribute to endothelial injury and atherosclerosis.
Host genetic factors, moreover, may modify the response to these environmental challenges, although inherited risk for stroke is likely multigenic. Even so, specific single-gene disorders with stroke as a component of the phenotype demonstrate the potency of genetics in determining stroke risk.
A number of genes are known to increase susceptibility to ischemic stroke. Mutations to the F2 and F5 genes are relatively common in the general population and increase the risk of thrombosis. Mutations in the following genes also are known to increase the risk of stroke:
NOS3: A nitric oxide synthetase gene involved in vascular relaxation
ALOX5AP: Involved in the metabolism of arachidonic acid
PRKCH: Involved in major signal transduction systems
Hyperhomocysteinemia and homocystinuria
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Can Small Vessel Disease In The Brain Be Reversed
Researchers discovered that the therapy, which is known as cerebral small vessel disease, can help to reverse alterations in blood vessels in the brain linked with the disorder. The treatment also avoids the damage to brain cells produced by these blood vessel modifications, increasing the possibility that it may be utilized as a dementia treatment in the future.
Symptoms Of Small Vessel Brain Disease
The symptoms can vary depending on the severity of damage to blood vessels and the area of brain affected. Patient with small vessel brain disease frequently suffers from thinking problems. It mainly develops as a person gets older. When the damage to the vessel is severe it can cause more serious condition called vascular dementia. Patients suffering from it have mild memory loss and his thinking ability is hampered. He is not able to concentrate or plan his task due to slowing of his memory.
Sudden change in mood is associated with small vessel brain disease. Patient feels depressed together with disturbance in his thinking ability. Patient often has uncontrolled laughing and crying spells. Mood swings, irritability, impatience are characteristic features. The symptoms are more prominent when they develop soon after a stroke caused due to damage to the small blood vessel. People suffering from stroke also suffer from difficulty in swallowing, speaking, moving limbs, paralysis of one side of body etc.
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Carotid Angioplasty And Stenting
An alternative, new form of treatment, carotid angioplasty and stenting, shows some promise in patients who may be at too high risk to undergo surgery. Carotid stenting is a procedure in which a tiny, slender metal-mesh tube is fitted inside your carotid artery to increase the flow of blood blocked by plaques. The stent is inserted following a procedure called angioplasty, in which the doctor guides a balloon-tipped catheter into the blocked artery. The balloon is inflated and pressed against the plaque, flattening it and re-opening the artery. The stent acts as scaffolding to prevent the artery from collapsing or from closing up again after the procedure is completed.
How Do Doctors Treat Ischemia
The treatment of ischemia begins with seeking regular medical care throughout your life. Receiving regular medical care allows a healthcare professional to provide early screening tests and promptly evaluate your symptoms and your risk of developing ischemia.
The goal of treating ischemia is to restore blood flow and prevent further damage. Surgery may be necessary to remove dead tissue or repair injured areas.
Once the initial event is under proper control, treatment will turn to the prevention of future ischemia.
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Hemorrhagic Transformation Of Ischemic Stroke
Hemorrhagic transformation represents the conversion of an ischemic infarction into an area of hemorrhage. This is estimated to occur in 5% of uncomplicated ischemic strokes, in the absence of fibrinolytic treatment. Hemorrhagic transformation is not always associated with neurologic decline, with the conversion ranging from the development of small petechial hemorrhages to the formation of hematomas that produce neurologic decline and may necessitate surgical evacuation or decompressive hemicraniectomy.
Proposed mechanisms for hemorrhagic transformation include reperfusion of ischemically injured tissue, either from recanalization of an occluded vessel or from collateral blood supply to the ischemic territory or disruption of the blood-brain barrier. With disruption of the blood-brain barrier, red blood cells extravasate from the weakened capillary bed, producing petechial hemorrhage or more frank intraparenchymal hematoma.
Spontaneous hemorrhagic transformation of an ischemic infarct occurs within 214 days postictus, usually within the first week. It is more commonly seen following cardioembolic strokes and is more likely to occur with larger infarct volumes. Hemorrhagic transformation is also more likely following administration of rt-PA in patients whose baseline noncontrast CT scans demonstrate areas of hypodensity.
When Specific Areas Of The Brain Are Damaged
Different areas of the brain control specific functions. Consequently, where the brain is damaged determines which function is lost.
Computed tomography is usually done first. CT helps distinguish an ischemic stroke from a hemorrhagic stroke, a brain tumor, an abscess, and other structural abnormalities.
Doctors also measure the blood sugar level to rule out a low blood sugar level , which can cause similar symptoms.
If available, diffusion-weighted magnetic resonance imaging Diffusion-weighted MRI In magnetic resonance imaging , a strong magnetic field and very high frequency radio waves are used to produce highly detailed images. MRI does not use x-rays and is usually very safe… read more , which can detect ischemic strokes within minutes of their start, may be done next.
Measures to support vital functions, such as breathing
Drugs to break up blood clots or make blood less likely to clot
Sometimes surgery to remove a blockage or angioplasty with a stent
Measures to manage problems that stroke can cause, such as difficulty swallowing
Measures to prevent blood clots in the legs
Another priority is to restore the persons breathing, heart rate, blood pressure , and temperature to normal. An intravenous line is inserted to provide drugs and fluids when needed. If the person has a fever, it may be lowered using acetaminophen, ibuprofen, or a cooling blanket because brain damage is worse when body temperature is elevated.
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Cerebral Small Vessel Disease
Now, perhaps the best technical term for what Im referring to is cerebral small vessel disease. But the medical community uses many other synonyms especially in radiology reports. They include: small vessel ischemic disease, white matter disease, periventricular white matter changes, perivascular chronic ischemic white matter disease of aging, white matter hyperintensities, age-related white matter changes and leukoaraiosis.
Cerebral small vessel disease is an umbrella term covering a variety of abnormalities related to small blood vessels in the brain. Because most brain tissue appears white on MRIs, these abnormalities were historically referred to as white matter changes.
Per a recent medical review article, specific examples of cerebral SVD include lacunar infarcts , white matter hyperintensities and cerebral microbleeds .
In many cases, cerebral SVD seems to be a consequence of atherosclerosis affecting the smaller blood vessels that nourish brain tissue. Just as ones larger blood vessels in the heart or elsewhere can accumulate plaque, inflammation and chronic damage over the years, so can the smaller blood vessels.
Such chronic damage can lead the small blood vessels in the brain to become blocked , or to leak .
When little bits of brain get damaged in these ways, they can change appearance on radiological scans. So when an MRI report says white matter changes, this means the radiologist is seeing signs of cerebral SVD.
What Causes Microvascular Ischemic Disease
The cause of microvascular ischemic disease is believed to be the result of atherosclerosis, which is caused by plaque buildup and hardening that damages the blood vessels. This narrowing of blood vessels can result in stroke and heart attacks.
This damage to the blood vessel can block blood flow and deprive the brain or heart cells of oxygen, or the blood vessels can break and bleed.
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Can Brain Ischemia Reversed
In order to treat an ischemic stroke, doctors must dislodge the blood clot, which can be accomplished by medication or surgery. tPA and aspirin are two common medications used to treat ischemic stroke, both of which assist thin the blood and remove the blood clot in the brain. When medications are unable to be utilized, surgeons may be forced to perform surgery to physically remove the clot.
What Is The Treatment For Microvascularischemic Disease
There is no cure for microvascular ischemic disease and the damage isnt reversible. You may be sent to physical therapy to deal with the effects on your body. They will also work to bring any other health conditions under control. This includes:
- Strict blood sugar control for diabetics
- Controlling hypertension
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Deterrence And Patient Education
Risk factors for cerebral ischemia include heart disease, including heart conditions such as atrial fibrillation, diabetes, obesity, hypertension, atherosclerosis/hyperlipidemia, and history of strokes. Behavioral risk factors include physical inactivity, poor sleep, obesity, excessive alcohol intake, and tobacco use. Sickle cell disease and other hematologic disorders, especially hypercoagulable conditions, can also increase the risk of ischemic stroke. Minimizing risk for stroke involves treating these conditions with a healthy diet, exercise, and medication adherence. In particular, statins and blood thinners have been proven to reduce the risk of ischemic stroke.
Is Brain Ischemia Serious
It is one of the three different forms of stroke that can occur. Ischemia of the brain and cerebral ischemia are other terms for this condition. It is believed that this form of stroke is caused by a blockage in an artery supplying blood to the brain. The obstruction decreases the amount of blood and oxygen that can reach the brain, causing damage or death of brain cells.
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How Is This Condition Spotted
Since there may be not symptoms at all, microvascular ischemic disease may go unnoticed until you have an MRI of your brain for other reasons. Many people discover they have this issue when undergoing MRI forcognitive impairment, migraine headaches, memory loss, symptoms of multiple sclerosis, or head injury.
Here are some pictures of MRI with and without blood vessel disease:
Figure 1: Normal MRI
In the picture above, there are no white spots seen in the brain tissue. Calcifications, narrowed blood vessels, and blockages show up as bright white or white spots in the tissue. They appear bright as if they were lit up.
Figure 2: MRI of the Brain with Ischemic Changes
In this MRI of the brain there are multiple white spots that appear very brightly in the brain tissue. These are signs of microvascular ischemic disease in the brain tissue. If the patient is given and infusion of gadolinium, the spots will appear even brighter on the MRI film. This is a type of contrast so the radiologist can differentiate different changes in brain tissue.
What Is Chronic Ischemic Change
Chronic microvascular ischemic change is a term that describes areas in the brain where tiny blood vessels have ruptured or clotted off, causing limited blood flow, or ischemia. It is a common finding in adults over 50 with certain chronic health conditions, such as high blood pressure, atherosclerosis or diabetes.
Brain ischemia occurs whenever blood flow to the brain is insufficient to meet metabolic demands. This results in decreased oxygen supply to brain tissue, which, in turn, causes tissue death. The medical term for this is cerebral infarction, or stroke. The term chronic cerebral ischemia describes a series of very small strokes that occur over a long time.
A stroke involving a large area of the brain typically causes severe injury and neurologic deficits, such as loss of vision, speech changes, paralysis and even death. However, in cases of chronic microvascular ischemia, the injured areas of the brain are so small and diffuse that few symptoms appear. Over time, some people with this condition experience minor deficits, such as cognitive changes, decreased memory or changes in vision. Research also indicates that long-term chronic ischemia possibly is associated with a more serious condition known as small vessel disease of the brain, a cause of age-related dementia.
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Can Brain Ischemia Be Cured
Recent tiny subcortical infarcts, lacunes, white matter hyperintensities, perivascular spaces, microbleeds, and brain shrinkage are all observed on neuroimaging studies of CSVD patients. Stroke, cognitive decline, dementia, mental problems, aberrant gait, and urine incontinence are the most common clinical signs of CSVD.
Risk Factors And Causes Of Lacunar Infarcts
Four possible main aetiologies for lacunar ischaemic stroke have been proposed : atheroma of parent arteries or perforating arterioles, embolism from the heart or carotid arteries, and intrinsic small vessel disease . Atheroma in MCA appears to cause < 20% of lacunar ischaemic stroke. In the Warfarin Aspirin Symptomatic Intracranial Disease trial, only 11% of all patients with stroke were lacunar type, which is surprising if MCA stenosis is supposed to be a common cause of lacunar stroke. A recent study also did not find any association between lacunar stroke and MCA stenosis. A systematic review of Asian studies showed that parent artery atherosclerosis accounted for 20% of single lacunar infarcts in anterior circulation territory however, these hospital-based studies were rather small and some were even retrospective. Larger and tubular lacunar infarcts might be more likely to be caused by proximal artery diseases. However, the results of both our study and the Secondary Prevention of Small Subcortical Stokes Trial suggest that it is not possible to identify the cause of a particular recent lacunar ischaemic stroke based on its size, shape or location.,
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Symptoms Of Cerebral Small Vessel Disease
The severity of symptoms tends to correspond to whether radiological imaging shows the cerebral SVD to be mild, moderate, or severe.
Many older adults with cerebral SVD will have no noticeable symptoms. This is sometimes called silent SVD.
But many problems have been associated with cerebral SVD, especially when it is moderate or severe. These include:
So what does this all mean, in terms of symptoms and cerebral SVD? Heres how I would boil it down: