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What Is Small Vessel Disease In The Brain

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How Is Microvascular Ischemic Disease Treated

Small vessel disease in the brain – Microscopic

There arent specific treatments for microvascular ischemic disease. Currently, treatment focuses on reducing risk factors and staving off complications, such as dementia and stroke.

Every person will have different risk factors, so treatment is highly personalized. In general, treatment may include:

  • Adopting healthy habits, such as exercising and eating more nutrients.
  • Taking medications to lower high blood pressure and control cholesterol and glucose levels.

Can Small Vessel Disease Be Prevented Or Avoided

The best way to prevent small vessel disease is by reducing your risk factors.

  • Lose weight. If you are overweight, create a weight loss plan with your doctor.
  • Dont smoke. Nicotine raises your blood pressure by causing your body to release adrenaline. It constricts your blood vessels and makes your heart beat faster. If you smoke, ask your doctor for help to quit.
  • Control your blood pressure. If you have high blood pressure, your doctor can suggest ways to lower it. Take medicines to treat high blood pressure should be taken with caution, per your doctors orders.
  • Improve your cholesterol levels. A healthy diet and exercise can balance your cholesterol levels. They lower your bad cholesterol and raise your good cholesterol . LDL blocks your blood vessels and increases your risk of developing heart disease. Medicine also can help with this.
  • Regular exercise strengthens your heart and reduces your risk of heart disease. Before you start, talk to your doctor about the right kind of exercise for you. Try to exercise at least 4 to 6 times a week for at least 30 minutes each time.
  • Eat a healthy diet. Add foods to your diet that are low in cholesterol and saturated fats. Foods that are low-fat and raise your HDL levels help reduce your risk of heart disease.
  • Manage diabetes. Work with your doctor to keep your blood sugar under control.

What Is Small Vessel Disease

Small vessel disease is a serious medical condition that adversely affects coronary arterial function and jeopardizes heart health. Frequently associated with the onset of atherosclerosis, SVD impacts an artery’s ability to expand in order to accommodate proper blood flow. The condition is usually detected in the presence of more pronounced arterial constriction as occurs with atherosclerosis. Treatment for SVD is centered on slowing the progression of arterial narrowing and improving blood flow with the use of medications and supplements.

With normal cardiovascular function, small blood vessels within the heart work alongside the main coronary arteries to circulate oxygenated blood throughout the body. Small blood vessels are designed to expand or contract according to ones level of activity to accommodate appropriate blood flow. Similar to atherosclerosis in its presentation, small vessel disease manifests as a constriction of the small blood vessels that impairs blood flow, jeopardizing circulation and heart function. Several factors may contribute to small blood vessel constriction and the development of small vessel disease, including plaque buildup, clot formation, and aneurysms.

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Causes And Risk Factors

The cause of microvascular ischemic disease isnt completely understood. It can be the result of plaque buildup and hardening that damages the small blood vessels nourishing the brain. This is the same process that narrows and damages blood vessels to the heart and can lead to heart attacks.

Damage can block blood flow through the blood vessels in the brain, depriving brain cells of oxygen. Or, it can cause blood vessels in the brain to leak and bleed, which can damage neighboring neurons.

Risk factors for microvascular ischemic disease include:

  • high blood pressure

Can I Reduce My Risk

The distribution of sporadic small vessel disease in the brain and the ...

By making healthy lifestyle changes, such as stopping smoking and exercising regularly, and treating any health conditions you have, you may be able to reduce your chances of getting vascular dementia.

This may also to help slow down or stop the progression of vascular dementia if you’re diagnosed in the early stages. Find out more about treating vascular dementia.

But there are some things you cannot change that can increase your risk of vascular dementia, such as:

  • your age the risk of vascular dementia increases as you get older, with people over 65 most at risk
  • your family history your risk of problems such as strokes is higher if a close family member has had them
  • your ethnicity if you have a south Asian, African or Caribbean background, your risk of vascular dementia is higher, as related problems such as diabetes and high blood pressure are more common in these groups

In rare cases, unavoidable genetic conditions can also increase your risk of vascular dementia.

Page last reviewed: 05 March 2020 Next review due: 05 March 2023

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What Is Small Ischemic Vessel Disease

Small ischemic vessel disease, also called white matter disease, occurs as a result of damage to the brains white matter from a variety of sources. This disease is detected through magnetic resonance imaging or computer tomography tests. Severe damage to the vessels and white matter can cause problems with the functions of the brain and how it controls the body, potentially leading to awkward movements and speech difficulties.

The brain has many small vessels that are responsible for distributing and regulating blood, fluid, and oxygen in the brain. Small ischemic vessel disease occurs when there is damage to either the vessels themselves or the surrounding white brain matter. This damage eventually affects the brain matter, which is diagnosed with an MRI or CT.

Causes of the disease include diabetes, a stroke, hypertension, and migraine headaches. Other damage can be the result of conditions such as atherosclerosis, which reduces blood flow to the brain. This reduction of blood causes damage to tissue and vessels, which is called ischemic injury.

Cerebral Small Vessel Disease Visual Ratings

Trained researchers using the same rating methods, and blind to all other data, performed all image analyses. An experienced certified and registered neuroradiologist cross-checked 20% of scans. The presence of WMH, lacunes, micro-bleeds and perivascular spaces were rated according to STRIVE criteria and established protocols, published previously using validated visual scales,,, converted to dichotomous point scores and summed to create the total SVD score ., We noted any imaging evidence of infarcts in the cortical or subcortical regions using a validated stroke lesion rating scale. Superficial and deep atrophy scores were coded separately using a valid template, summed to give a total score and dichotomized into none or mild and moderate or severe.

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What Is Microvascular Ischemic Disease

Microvascular ischemic disease is an umbrella term that refers to a variety of changes in the small blood vessels of your brain. Depending on the severity of these changes, they can cause a range of complications from difficulty focusing to a stroke.

Microvascular ischemic disease has many names, such as:

  • Cerebral small vessel disease .
  • Chronic microvascular ischemic disease.
  • Small vessel ischemic disease.

Causes Of Small Vessel Brain Disease: Symptoms And Treatment

Cerebral small vessel disease progression linked to MCI in hypertensive patients

The big vessels from the heart traveling to brain divide into smaller vessels inside the brain. The smaller vessels supply oxygen and other nutrients present in the blood to each and every brain cell for its proper functioning. However, this network of small blood vessels can get damaged or narrow as the person become old or in conditions such as high blood pressure, high cholesterol, diabetes etc.

Small vessel damage can lead to inadequate supply of blood to the brain. It can produce harm to the brain cells. The damage can be either due to blockage or rupture of the blood vessel.

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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.

What Causes Chronic Small Vessel Disease Of The Brain

In the edlerly, the damage to the brain is most likely caused by multiple tiny bleeds in the brain. This is a natural consequence of ageing, and some extent of small vessel disease of the brain is common in by the time a person reaches 80 years old.

Small vessel disease is much rarer in younger people, however. In younger people it is most often caused by a disease process or high blood pressure. High blood pressure weakens and damages the tiny vessels in the brain. These vessels ultimately break and cause micro-bleeds and multiple tiny strokes. People with Chronic Small Vessel Disease are at a far higher risk of experiencing a major haemorrhagic stroke. Lacunar strokes, usually small strokes caused by a blockage of the small arteries that supply the brains deep structures, are also common. The extent of symptoms and deficits depend on the location and size of the strokes.

Diabetes is also a risk factor. High blood glucose levels can damage blood vessels and increase the risk of atherosclerosis .

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Assessment And Clinical Meaning

We defined WMH as an irregular periventricular hyperintensity and/or early confluent or confluent separate deep white matter hyperintense lesions on FLAIR images . We defined SLI as a focal lesion of 3 mm in diameter, with hyperintensity on T2-weighted MRI and hypointensity on FLAIR . We defined MB as a focal area of signal loss in the brain parenchyma < 5 mm in size on T2* scans .

Cerebral SVD is the most common vascular cause of stroke and dementia, and is a major contributor to mixed dementia . In fact, these lesions are not silent’, but rather they slowly increase the risk of stroke and dementia in the brain. For example, as the numbers of SLI and MB increase, the risk of cerebrovascular diseases and cognitive impairment increases. Likewise, as the area of WMH enlarges, the risks of disease increase. Age and hypertension are well-known risk factors for cerebral SVD . Pulse pressure and blood pressure variability may also contribute to the risk of cerebral SVD and cardiovascular and cerebrovascular diseases .

What Causes Small Vessel Disease In The Brain

Representative brain MRI of cerebral small vessel disease in patients ...

Small vessel brain disease is caused due to diminished supply of blood to the brain cells. Reduced or complete stoppage of blood flow eventually leads to death of brain cells in the affected area. It can occur due to number of reasons:

  • Narrowing of tiny blood vessels in brain.
  • Stoppage of blood flow to brain due to a clot inside the blood vessel which may result in stroke.
  • Mini strokes caused due to multiple tiny damages in the blood vessel. They are called multi infarcts.

People at risk of small vessel brain disease are:

  • Those having high blood pressure.
  • People with high blood cholesterol.
  • Obese persons.
  • Brain hemorrhage.

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What Causes Cerebral Small Vessel Disease

This is a topic of intense research, and the experts in this area tend to really nerd out when discussing it. One reason its difficult to give an exact answer is that cerebral SVD is a broad umbrella term that encompasses many different types of problems with the brains small blood vessels.

Still, certain risk factors for developing cerebral SVD have been identified. Many overlap with risk factors for stroke. They include:

  • Hypertension
  • Age

White Matter Hyperintensity Volumes And Whole Brain Volume

We conducted structural image analysis, blind to all non-imaging data, including measurements of volumes of the intracranial compartment, whole brain and total WMH volume in STRADL, LBC1936 and the Simpsons cohort and WMH volume only in the Dutch Famine Birth Cohort. For tissue segmentation we used the processing protocol with the lesion growth algorithm , provided by the Lesion Segmentation Toolbox for SPM and a semi-automatic segmentation tool MCMxxxVI previously validated . We visually inspected all segmented images and manually edited any incorrectly classified tissues. Analyses were performed using Freesurfer 5.3 and AnalyzeTM software.

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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.

Image Processing And Analysis

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

For each analysis, investigators were blinded to participant demographic and clinical data and other outcome data . Structural image analysis of SVD features was performed according to the STRIVE criteria under the supervision of an expert neuroradiologist .

We scored the following features: WMHs using the Fazekas scale, summing periventricular and deep WMH scores to give a score from 0 to 6 perivascular spaces , scored separately in the basal ganglia and centrum semiovale, using a validated, semiquantitative ordinal scale lacunes and microbleeds presence/absence and total number atrophy score by reference to a normative age template and total SVD score by combining WMHs, lacunes, microbleeds, and PVS scores, as described previously.

We processed CVR images as described previously. We generated voxel-wise CVR maps by regressing the BOLD signal against EtCO2 and the BOLD scan number . CVR is expressed as % BOLD signal change/mm Hg change in EtCO2, based on the EtCO2 regressor in the model. We made additional adjustment for the delay time between BOLD signal change and EtCO2 change to minimize the residual sum of squares individually for each voxel, further adjusted by 4 seconds to account for the delay between exhalation and detection on the EtCO2 monitor caused by the 8-m-long EtCO2 sample tubing.

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How To Prevent Cerebral Small Vessel Disease

The best, and most promising, way to prevent cerebral small vessel disease is to manage any health problems, such as high blood pressure or diabetes, you may have that can cause plaque buildup or inflammation to the veins. Managing these health problems can reduce your risk of experiencing small vessel disease of the brain.

Typically, if you have vein disease in one part of the body, such as the brain, you could have it in other parts of the body like your legs or near your heart. If you have been recently diagnosed with small vein disease in the brain, you may want to consider making an appointment at a local Cincinnati vein treatment clinic such as Vascular & Interventional Associates Vein Center.

Visit the website of Vascular & Interventional Associates Vein Center to schedule an appointment, learn more about treatment options, and to see before & after photos of various vein treatment procedures that are performed at the clinic.

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Imaging Morphologic Substrates Of Svd

Neuroimaging provides important information on neuroanatomical substrates of the disorder, plays an important role in the diagnosis, and adds to prediction of VaD. Whereas CT is still the leading imaging study in the management of acute stroke, MRI remains the key neuroimaging modality in VaD . If not contraindicated, MRI, rather than CT, is preferred for research and routine clinical use because it has higher sensitivity and specificity for detecting pathologic changes. Standards for neuroimaging with a widely accepted terminology permitting comparison of findings between centers have been recommended . Numerous studies identified MRI markers of SVD as determinants of VaD . Vascular lesions traditionally attributed to VCI comprise subcortical areas of the brain, especially subfrontal white matter circuits, strategic areas of single infarction such as the dominant thalamus or angular gyrus, deep frontal areas and the left hemisphere, and bilateral brain infarcts or volume-driven cortical-subcortical infarctions reaching a critical threshold of tissue loss or injury . Recently, enlargements of perivascular spaces were identified as MRI markers of SVD. These are associated with the pathogenesis of vascular-related cognitive impairment in older individuals . The burden of SVD as a risk of stroke is increased in type 2 diabetes .

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