Wednesday, April 27, 2022

What Is Chronic Small Vessel Ischemic Disease Of The Brain

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Ultrasonography Of The Carotid Arteries

Chronic ischemic small vessel disease and chronic ischemic white matter changes explained.

All ultrasound measurements will be performed by three experienced and specific trained clinical neurophysiology technicians. A carotid ultrasound assessment at which the intima media thickness is measured in the distal left and right carotis communis, near the bulbus, will be performed. All measurements will be performed using a phased array real-time scanner with a 17-5 MHz broadband linear transducer. Two-dimensional ultrasound imaging of the carotid artery will be performed to measure the IMT. The IMT will be automatically measured by QLab® qualification software . An edge detection algorithm identified the lumen/intima and the media/adventitia interfaces within a region of interest over a 10 mm long segment and calculated the average thickness .

The same cognitive, motor, gait and balance assessment, structured interview and assessment of other variables and the same ancillary investigation were performed at baseline in 2006.

What Is Small Vessel Ischemic Disease

Small vessel ischemic disease is also known as microvascular Ischemic or lacunar infarcts disease.

The condition describes disorders affecting the small vessels of the brain. Small vessel ischemic disease entails a situation where injuries to arterioles and capillaries are predominant, resulting in reduced and interrupted brain perfusion.

The brain is primarily affected by this disease, but the disease has been associated with other vital organs in a few cases.

Medical specialists employ the term microvascular ischemic disease to refer to tiny changes or complications that are observed in the walls of the blood vessels of the brain or other affected organs.

Most conditions that affect these micro-vessels can damage the brains white matter .

Due to the low mortality of small vessel ischemic disease and barely accurate postmortem evidence, the current body of knowledge and understanding of small vessel ischemic disease is still immature.

However, traces of facts that seem to describe a condition similar to small vessel ischemic disease were found in literature dating back to the late nineteenth century.

It was not till the late twentieth century that doctors and medical researchers began to examine the pathophysiology and clinical manifestations of cerebral ischemic disease .

Small vessel ischemic disease is a persistent neurological disease in older individuals. It can cause stroke, dementia, mood disturbance , and gait problems without prompt treatment.

Does Age Play A Part

Sometimes people think that its too late to change their habits once they get to a certain age. This is not true its never too late.

We study the little scars with special brain scans and recently found that they could disappear if high blood pressure was brought under control and possibly other lifestyle changes were adopted.

Our research has shown that not smoking and eating less salt may help to stop scars from forming. We also found that taking more exercise means you are less likely to get scars and this will reduce problems with loss of thinking and memory as you get older.

Soon, we hope to have treatments to reduce scars, but meantime, avoiding them reduces the risk of stroke and dementia, so is very important!

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Citation Doi And Article Data

Citation:DOI:Dr Yuranga WeerakkodyRevisions:see full revision historySystem:

  • Chronic small vessel ischaemic disease
  • Age-related white matter disease
  • Small vessel chronic ischaemia

Cerebral small vessel disease is an umbrella term for lesions in the subcortical brain attributed to pathologic changes in the small vessels. It is the most common cause of vascular dementia/cognitive impairment and is a major cause of ischemic and hemorrhagic strokes.

Symptoms Of Small Vessel Brain Disease

Example of small

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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Brain Ischemia Types And Causes

Brain ischemia, also known as cerebral ischemia or cerebrovascular ischemia, occurs when there is an insufficient amount of blood flow to the brain. Oxygen and vital nutrients are carried in the blood through arteriesthe blood vessels that carry oxygen and nutrient-rich blood to every part of the body.

The arteries that provide blood to the brain follow a certain pathway that ensures every region of the brain is adequately supplied with blood from one or more arteries. When an artery in the brain becomes blocked or bleeds, this leads to a lower oxygen supply to the region of the brain that relies on that particular artery.

Even a temporary deficit in oxygen supply can impair the function of the oxygen-deprived region of the brain. In fact, if the brain cells are deprived of oxygen for more than a few minutes, severe damage can occur, which may result in the death of the brain tissue. This type of brain tissue death is also known as a cerebral infarction or ischemic stroke.

Csvd As A Dynamic Disease

There is increasing evidence showing that CSVD is more dynamic than originally thought. Lesions progress over time and the long-term outcome and impact on brain damage vary. Cavitation is not the only fate of acute lacunar ischaemic stroke. An acute lacunar ischaemic stroke can also disappear or resemble a WMH . In a prospective study , definite cavitation was only present in 20% of patients, and was marginally associated with increasing time from stroke onset to follow-up scans. A large proportion of lacunar lesions remained looking like WMH. Thus, only calculating cavitated lacunes could lead to a large underestimation of lacunar ischaemic stroke burden. Similarly, WMH burden is likely to be overestimated without previous scans of index stroke lesions.

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Who Is A Candidate For Svd

A paper published in 2007 by Vermeer et al. outlined the conditions associated with MRI-defined silent brain infarcts . The highest associations were noted with prior stroke, cardiovascular risk factors, and the presence of renal failure . This article also identified depression as having a strong association with silent brain infarcts, a link that has been confirmed subsequently . A 2014 study that specifically tested the association of total SVD score with vascular risk factors confirmed that smoking, hypertension, male sex, and advancing age were conditions that promoted brain SVD . In a separate study, SVD was observed in 3% of 4049-year-olds but 18.9% of 70-year-olds, highlighting the association of SVD with aging .

Obesity’s impact on the development of brain small vessel disease is now well-documented . A 2017 review concluded that obesity and its comorbidities were associated with impaired cognitive performance, accelerated cognitive decline and dementia in later life , confirming the conclusion of a systematic review by Pedditzi et al., published a year earlier . In the setting of obesity there is a significant rise in the factors promoting inflammation, leading to the conclusion that accumulated fat, particularly in its abdominal location, is a source for inflammatory cytokines . It is perhaps not surprising therefore that obesity has been associated with smaller brain volumes .

Use Of Brain Imaging Appearances To Predict Risk Of Svd Progression

Small vessel disease in the brain – Microscopic

The lesions seen on MRI adopted as biomarkers of SVD include recent small subcortical infarct , WMH, lacune, CMB, visible PVS, and cerebral atrophy. All of these lesions have been associated with dysfunction of the cerebral small vessels when measured in patients using MRI, including blood-brain barrier leakage, impaired cerebral vasoreactivity and increased vascular pulsatility, reflecting impaired endothelial function and related effects on the glia and neurons. These lesions are individually and collectively associated with increased risk of stroke, cognitive decline and dementia, and poor functional outcomes after stroke, and are highly heritable.

The single strongest risk factor for SVD lesion progression identified so far is having a severe SVD lesion burden at presentation. Potential advances in neuroimaging of SVD based on MRI, e.g. diffusion tensor imaging metrics such as fractional anisotropy and mean diffusivity , show promise in research for detecting early white matter damage and may in future become widely used clinical applications.

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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:

  • Overall, older adults with any of the problems listed above have a high probability of having cerebral SVD.
  • But, many older adults with cerebral SVD on MRI are asymptomatic, and do not notice any difficulties. This is especially true of those with mild cerebral SVD.
  • Older adults with cerebral SVD are at increased risk of developing the problems above, often within a few years time. This is especially true of people with moderate or severe cerebral SVD.
  • Diagnosing Chronic Microvascular Ischemic Disease

    It’s normally diagnosed when an MRI is done for other reasons. There usually arent any symptoms in healthy people, so it isnt something doctors would look for without a reason to look.

    If you do have symptoms the doctor may do a mental exam to look for behavioral changes and memory loss. If that shows signs of a problem, an MRI and or a CT scan will be ordered to see the changes inside the blood vessels in the brain.

    Figure: Chronic Microvascular Ischemic Disease MRI Sample

    This MRI was done for a 62-year old woman who suffered from migraine headaches. An MRI was done four years prior with some of the changes see above. This MRI follow-up showed more spots and changes than the prior MRI so the patient was diagnosed. At the time of diagnosis, the patient showed signs of memory loss with a 2-year history of multiple falls. There is a medical history of diabetes and hypertension. Based on the criteria and the MRI results, the doctor was able to make the diagnosis.

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    Clinical Manifestation Of Csvd

    The clinical manifestations of CSVD vary depending on the specific cause of the disease, as well as the brain regions affected. Individuals may present sudden onset stroke symptoms, progressive cognitive deterioration, dementia, gait disorder, sphincter dysfunctions, and psychiatric disorders, etc..

    S For Searching Identifying Selecting And Synthesizing Data

    Chronic Microvascular Ischemic Changes

    We searched Ovid MEDLINE using the terms âCerebral Small Vessel Diseases/â or âWhite matter hyperintensââ and âClinicalâ from inception to April 3, 2020. We separately searched âLacunar stateâ or âBinswangerâ. On risk factors for SVD and its progression, we searched Ovid MEDLINE using the terms âCerebral small vessel diseaseâ OR âWhite matter hyperintensââ AND âvascular risk factorâ OR ârisk factorâ AND âdisease progressââ OR âoutcomeâ up to June 5th 2020. On therapeutic approaches to SVD, we searched Ovid MEDLINE using the terms âCerebral small vessel diseaseâ OR âWhite matter hyperintenseââ OR âlacunarâ OR âvascular cognitive impairmentâ up to 12th May 2020. We supplemented the electronic search with the authorsâ personal files and searched reference lists of identified papers. We screened 2169 papers for clinical diagnosis, 1094 for risk factors and progression, and 7695 for interventions in SVD, including the most relevant papers reporting SVD associations.

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    Svd And The Risk For Dementia

    The powerful message in all of this is that we need to explore the premise that individuals and societies may succeed in lowering their risk for dementia by reducing vascular risk factors and changing potentially harmful lifestyles. A review of advances in stroke research accomplished during 2018 confirms the impact of adverse lifestyle exposures on brain health and on cognition . Decades ago the lesson was established that a successful cure is dwarfed in its societal impact by a reduction in risk, and books intended for the public are now available with advice on how to achieve the goal of reducing the risk for dementia .

    White Matter Scars In The Brain

    As people get older, it is common to find that the brain develops little scars. They look like white dots or patches in brain scans. They are like tiny injuries and mainly affect the brains white matter the wiring connections between the brain cells .

    The little scars used to be thought of as an inevitable consequence of ageing, like wrinkles on the skin or hair going grey. However, we now know that they are not a natural part of ageing.

    In fact, having more little scars is a sign of serious damage. They affect the ability to think clearly and quickly. They can also lead to decline in mobility and mood. If severe, they can lead to dementia and stroke.

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    Cerebrovascular Diseases And Stroke

    Cerebral ischemia or brain ischemia, is a condition that occurs when there isnt enough blood flow to the brain to meet metabolic demand. This leads to limited oxygen supply or cerebral hypoxia and leads to the death of brain tissue, cerebral infarction, or ischemic stroke. It is a sub-type of stroke along with subarachnoid hemorrhage and intracerebral hemorrhage.

    There are two kinds of ischemia:

    • focal ischemia: confined to a specific region of the brain
    • global ischemia: encompasses wide areas of brain tissue.

    Defining The Natural History Of Clinical Cerebral Small Vessel Disease

    Ischemic Brain Disease/Stroke

    The earliest clinicopathological reports by Binswanger in 1894, based on eight post-mortem cases, described âencephalitis subcorticalis chronica progressivaâ, characterized pathologically by pronounced white matter atrophy and cortical thinning and clinically by a progressive, fluctuating course, arising predominantly in males in their 50s, characterized by chronic cognitive and emotional symptoms, and occasionally punctuated by acute hemiplegic episodes.

    In 1901, Marie described âlâtat lacunaireâ or âthe lacunar stateâ, involving one or more lacunes on neuropathology, characterized by progressive neurological decline, episodes of mild hemiparesis, and later, dysarthria, marche à petit pas , imbalance, incontinence, pseudobulbar signs, and dementia.

    Much remains unknown about its precise natural clinical history: the disease is elusive in its early stages unless the patient has overt symptoms that are easily recognized from the current neurological lexicon for stroke or dementia .3]. Proposed pathophysiological mechanisms underlying SVD are outside the scope of this review but are described in detail elsewhere. We describe acute and chronic clinical and neuroimaging manifestations at various SVD stages.

    Defining the trajectory of small vessel disease. MCI: Mild cognitive impairment.

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    Treatment Of Small Vessel Disease Of The Brain

    There is no treatment for Chronic Small Vessel Disease. The focus is to reduce risk factors and preventing further damage. These include reducing blood pressure, blood cholesterol and keep blood sugar levels in the normal range. This can be achieved with lifestyle changes, such as following a healthy diet and exercising. If lifestyle changes arent enough, medications to lower blood pressure and cholesterol are considered. Blood sugar levels also need to be well controlled.

    Small Vessel Ischemic Disease Of The Brain And Brain Metastases In Lung Cancer Patients

    • Affiliation Respiratory Institute, The Cleveland Clinic, Cleveland, Ohio, United States of America

    • Affiliation Cell Biology, The Cleveland Clinic, Cleveland, Ohio, United States of America

    • Affiliation Cell Biology, The Cleveland Clinic, Cleveland, Ohio, United States of America

    • Affiliation Neurological Institute, The Cleveland Clinic, Cleveland, Ohio, United States of America

    • Affiliation Neurological Institute, The Cleveland Clinic, Cleveland, Ohio, United States of America

    • Affiliation Neurological Institute, The Cleveland Clinic, Cleveland, Ohio, United States of America

    • Affiliation Florida Hospital Cancer Institute, Orlando, Florida, United States of America

    • Affiliation Cell Biology, The Cleveland Clinic, Cleveland, Ohio, United States of America

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    How Is It Diagnosed

    Advances in medical imaging have made white matter disease easier to spot. A magnetic resonance imaging test, which takes pictures of the inside of your brain, can show any damage. Changes to white matter will show up super-bright white on an MRI scan. You may need more tests to rule out other causes.

    Chronic Microvascular Ischemic Disease May Be Nothing To Be Worry About Or Very Serious Depending On Your Health Learn When To Be Concerned And Treatment Options

    Update on cerebral small vessel disease: a dynamic whole ...

    Microvascular ischemic disease is a sign that there is reduced blood flow to areas of the brain. Many people who have an MRI of the brain turn out to have this condition as a result of the aging process. Arteries with age can become more rigid and narrow and less able to send blood to some of the areas. This is most common with certain health conditions like high blood pressure, diabetes, and elevated cholesterol. It can even be found in healthy people without chronic health problems. If there are no symptoms, your doctor may just recommend living a healthy lifestyle, eating healthy, and not smoking.

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    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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