scholarly journals Tracer kinetic assessment of blood-brain barrier leakage and blood volume in cerebral small vessel disease: associations with disease burden and vascular risk factors

2021 ◽  
pp. 102883
Author(s):  
Michael S. Stringer ◽  
Anna K. Heye ◽  
Paul A. Armitage ◽  
Francesca Chappell ◽  
Maria del C. Valdés Hernández ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Volume ◽  
Disease Burden ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Vascular Risk ◽  
Vessel Disease ◽  
Disease Associations ◽  
Kinetic Assessment ◽  
Tracer Kinetic

Abstract TP407: Effects of Remote Ischemic Conditioning on Cerebral Small Vessel Disease Outcomes

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Yuan Wang ◽  
Haiqing Song ◽  
Kai Dong ◽  
Ran Meng ◽  
Shuying Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Flow Velocity ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Vascular Risk Factors ◽  
Control Group ◽  
Vascular Risk ◽  
Remote Ischemic Conditioning ◽  
Ischemic Conditioning ◽  
Vessel Disease

Objective: To evaluate the preliminary efficacy of remote ischemic conditioning (RIC) on patients with cerebral small vessel disease (SVD). Methods: Thirty patients diagnosed with symptomatic SVD within 30 days of onset were enrolled in this prospectively randomized controlled study for 1 year. All patients received routine medical treatment including treating vascular risk factors according to the guideline. Patients in the experimental group (n=14) were administered 5 cycles consisting of ischemia followed by reperfusion for 5 minutes on bilateral upper limbs twice daily for 1 year. Those in the control group (n=16) underwent sham ischemia-reperfusion cycles. Primary outcome was the change of cognitive function measured by mini-mental state examination (MMSE) and montreal cognitive assessment scale (MoCA), and secondary outcomes were changes of plasma biomarkers, cerebral hemodynamic parameters measured by vascular ultrasound and brain lesions measured by MRI FLAIR both at baseline and at the end of 1 year visit. Results: Compared with patients in the control group, patients in the RIC group had higher flow velocity (FV), and lower pulsatility index (PI), but without statistical difference. Patients in the RIC group had improvement in visuospatial and executive abilities (3.86±1.03 vs. 4.43±0.85, p=0.026), reduced plasma triglyceride (1.60±0.74 vs. 1.25±0.38, p=0.019), low density lipoprotein (2.89±0.81 vs. 2.26±0.67, p=0.003) and homocysteine (15.66±10.11 vs. 13.66±9.80 p=0.017). Similarly in the RIC group, the diastolic flow velocity (DFV) of middle cerebral artery (MCA) (right: 33.93±7.67 vs. 36.93±6.12, p=0.032; left: 33.93±7.67 vs. 36.93± 6.12, p=0.032) and the mean flow velocity (MFV) of left MCA (35.00±5.04 vs. 39.50±5.59, p=0.003) increased, and the PI of MCA (right: 1.11±0.19 vs. 1.02±0.14 p=0.030; left: 1.10±0.22 vs. 0.99±0.14, p=0.037) decreased. Conclusion: RIC appears to be potentially effective for improving cognition, enhancing cerebral perfusion, and modifying vascular risk factors in SVD patients. Further studies focusing on long-term neurological outcomes and potential mechanisms underlying RIC on SVD patients are needed.

scholarly journals Risk factor profile of different clinical manifestations of cerebral small vessel disease - data from SHEF-CSVD Study

2017 ◽  
Author(s):  
J. Staszewski ◽  
E. Skrobowska ◽  
R. Piusińska-Macoch ◽  
B. Brodacki ◽  
A. Stępień
Keyword(s):  
Risk Factors ◽  
Uric Acid ◽  
Risk Factor ◽  
Cerebrovascular Disease ◽  
Fasting Glucose ◽  
Small Vessel Disease ◽  
Clinical Manifestations ◽  
Cerebral Small Vessel Disease ◽  
Vascular Risk ◽  
Vessel Disease

AbstractBACKGROUNDLittle is known of the mechanisms of cerebral small vessel disease (CSVD). Both atherosclerosis or non-atherosclerotic diffuse arteriopathy are involved.METHODSA single-center, prospective, case-control study was performed in consecutive patients with different CSVD manifestations. The study group consisted of 205 patients: 52 with lacunar stroke (LS), 20 with subcortical hemorrhagic stroke (HS), 50 with vascular dementia (VaD), 28 with vascular parkinsonism (VaP) and 55 controls (CG) free of cerebrovascular disease but with high vascular risk.RESULTSPatients with CSVD had significantly higher prevalence of vascular risk factors including hypertension, diabetes mellitus, polymetabolic syndrome and chronic kidney disease. Patients with CSVD had also significantly higher fasting blood glucose, homocysteine, fibrinogen, systolic blood pressure, IMT values and lower eGFR, albumin and HDL levels. After adjustment for age and sex, low eGFR, albumin and high levels of uric acid and fibrinogen were associated with all CSVD groups, elevated fasting glucose was related to LS and HS. In the multivariate analysiss, the independent predictors for CSVD were female sex, low albumin, high fibrinogen, fasting glucose and uric acid. Patients with LS had significantly higher IMT values comparing to other CSVD groups, patients with VaP had a trend towards higher homocysteine levels.CONCLUSIONRisk factor profile for CSVD as a whole differs from subjects with proatherogenic profile without history of cerebrovascular disease. Our results support the concept that CSVD is not homogeneous, and that unique risk factors profiles exist for different clinical manifestations of the disease.

scholarly journals A Case of Sporadic Cerebral Small Vessel Disease in an Identical Twin

2020 ◽  
Vol 12 (3) ◽  
pp. 416-421
Author(s):  
Hilde van den Brink ◽  
Nick A. Weaver ◽  
Geert Jan Biessels
Keyword(s):  
Risk Factors ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Vascular Risk Factors ◽  
Small Vessel ◽  
Vascular Risk ◽  
Vessel Disease ◽  
Causative Factors ◽  
Potential Risk Factors ◽  
Clinical Consequences

Sporadic cerebral small vessel disease (cSVD) is primarily attributed to heritability and vascular risk factors. Still, our understanding of the causative factors in cSVD lesion burden in the brain is far from complete. This is exemplified by this case of identical twins with remarkably similar vascular risk profiles, where one twin had developed severe cSVD on neuroimaging with cognitive deficits, while the other twin had no cSVD. This case highlights the need to search for further causes of cSVD, also beyond genetic and conventional vascular risk factors. Identification of other potential risk factors or disease mechanisms should be a priority for cSVD research to improve our understanding, prevention and treatment of this common cause of vascular brain injury with major clinical consequences.

scholarly journals Stroke subtype, vascular risk factors, and total MRI brain small-vessel disease burden

Neurology ◽  
2014 ◽  
Vol 83 (14) ◽  
pp. 1228-1234 ◽  
Author(s):  
J. Staals ◽  
S. D. J. Makin ◽  
F. N. Doubal ◽  
M. S. Dennis ◽  
J. M. Wardlaw
Keyword(s):  
Risk Factors ◽  
Disease Burden ◽  
Small Vessel Disease ◽  
Vascular Risk Factors ◽  
Small Vessel ◽  
Vascular Risk ◽  
Stroke Subtype ◽  
Vessel Disease ◽  
Mri Brain

Abstract WP430: Long Chain Polyunsaturated Fatty Acids, Cerebral Small Vessel Disease and Incident Dementia

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Kaori Miwa ◽  
Shuhei Okazaki ◽  
Manabu Sakaguchi ◽  
Hideki Mochizuki ◽  
Kazuo Kitagawa
Keyword(s):  
Risk Factors ◽  
Fatty Acids ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Vascular Risk ◽  
Omega 3 ◽  
Mri Findings ◽  
Vessel Disease ◽  
Omega 6 ◽  
Long Chain

Objective: Long-chain omega-3 polyunsaturated fatty acids (PUFAs) have been identified as a potential protective factor for vascular events and cognitive impairment. However, few prospective studies have so far explored the impact of PUFAs on dementia while simultaneously controlling for MRI-findings, such as cerebral small-vessel disease (SVD) and brain atrophy. Methods: Within a cohort of Japanese participants with vascular risk factors and free of dementia, we evaluated the association between PUFAs levels, MRI-findings at baseline, and incident all-cause dementia. Circulating plasma levels of omega-3 (ie, eicosapentaenoic acid [EPA], docosahexaenoic acid [DHA]) and omega-6 (ie, dihomo-γ-linolenic acid [DGLA], arachidonic acid [AA]) PUFAs were measured at baseline. Baseline brain MRI was used to determine SVD (lacunas, white matter hyperintensities and cerebral microbleeds) and atrophy (medial-temporal lobe atrophy and bicaudate ratio). Logistic regression analyses were used to estimate the cross-sectional association between tertile of each PUFAs and MRI-findings. Cox proportional hazards analyses were performed to estimate the longitudinal association between PUFAs and dementia, adjusting for age, sex, APOEε4, educational level, vascular risk factors, cerebrovascular events, estimated glomerular filtration rate, and MRI-findings. Results: In the 613 subjects (age: 67.3 ± 8.4 years, male: 59%), multivariable analyses adjusted for potential confounders showed that any PUFAs was not significantly associated with each of SVD. During the mean 7.5-year follow-up (range: 3-13), 48 subjects were diagnosed with dementia (Alzheimer’s disease:24; vascular dementia:18; mixed-type:4; other: 2). In multivariable Cox models adjusted for confounders, the relative risk of all-cause dementia was 0.42 (95%CI, 0.17-0.96, p=0.040) in the highest versus lowest tertile of DHA levels. However, no significant associations with dementia were observed for circulating EPA, EPA/AA ratio, or omega-6 PUFAs. Conclusions: Our results provide additional evidence of DHA may be associated with lower risk of dementia.

scholarly journals Plasma Biomarkers of Inflammation, Endothelial Function and Hemostasis in Cerebral Small Vessel Disease

2015 ◽  
Vol 40 (3-4) ◽  
pp. 157-164 ◽  
Author(s):  
Stewart J. Wiseman ◽  
Fergus N. Doubal ◽  
Francesca M. Chappell ◽  
Maria C. Valdés-Hernández ◽  
Xin Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Endothelial Dysfunction ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
The Other ◽  
Vascular Risk ◽  
Baseline Model ◽  
Plasma Biomarkers ◽  
Vessel Disease

Background: The cause of lacunar ischemic stroke, a clinical feature of cerebral small vessel disease (SVD), is largely unknown. Inflammation and endothelial dysfunction have been implicated. Plasma biomarkers could provide mechanistic insights but current data are conflicting. White matter hyperintensities (WMHs) are an important imaging biomarker of SVD. It is unknown if plasma biomarkers add predictive capacity beyond age and vascular risk factors in explaining WMH. Methods: We prospectively recruited patients presenting with non-disabling ischemic stroke, classifying them clinically and with the help of MRI as lacunar or cortical. We measured biomarkers of inflammation, endothelial dysfunction and hemostasis for >1 month after stroke and compared biomarker levels between stroke subtypes. We quantitatively calculated WMH. We used multiple linear regression analysis to model WMH as a function of age, sex, hypertension and smoking (the baseline model). We fitted exploratory models using plasma biomarkers as predictor variables to assess model improvement over baseline. Results: We recruited 125 patients. The lacunar group (n = 65) had lower tissue plasminogen activator (t-PA) levels in unadjusted (7.39 vs. 8.59 ng/ml, p = 0.029) and adjusted (p = 0.035) analyses compared with the cortical group (n = 60). There were no significant differences in the other plasma biomarkers. The results for t-PA were consistent with an updated meta-analysis, although the effect remains non-significant (standardized mean difference -0.08 (95% CI -0.25 to 0.09)). The baseline regression model explained 29% of the variance in quantitative WMH (R2 0.289). Inflammatory biomarkers showed minor improvement over baseline (R2 0.291), but the other plasma biomarkers did not improve the baseline model. Conclusion: Plasma t-PA levels appear to differ between lacunar and cortical stroke subtypes, late after stroke, independent of age, sex and vascular risk factors and may reflect endothelial dysfunction. Except for a minor additional predictive effect of inflammatory markers, plasma biomarkers do not relate to WMH severity in this small stroke population.

Abstract TP322: Small Vessel Disease Burden Alters the Clinical Phenotype of Acute Hypertensive Crises

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Mehmet Yasir Pektezel ◽  
Mehmet Akif Topcuoglu ◽  
Rahsan Gocmen ◽  
Bulent Erbil ◽  
Mehmet Mahir Kunt ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Characteristics ◽  
Disease Burden ◽  
Small Vessel Disease ◽  
Clinical Phenotype ◽  
Hypertensive Crisis ◽  
Small Vessel ◽  
Imaging Features ◽  
Vascular Risk ◽  
Vessel Disease

Background: Acute elevations in systemic blood pressure are associated with a wide array of manifestations involving the central nervous system, ranging from no overt neurologic symptoms or signs to catastrophic scenarios like intracerebral hemorrhage (ICH). Very little is known regarding the determinants of this clinical variability. In this study we determined clinical and imaging features of neurologically asymptomatic hypertensive crisis patients, patients with hypertensive ICH and hypertensive posterior reversible encephalopathy syndrome (PRES). Methods: Magnetic resonance imaging (MRI) data was prospectively collected from a consecutive series of patients admitted to the emergency department with a diagnosis of hypertensive urgency or emergency but no neurologic symptoms. Features of small vessel disease (lacunes, microbleeds, perivascular spaces, white matter hyperintensities) were rated and small vessel disease burden score was determined. These features, together with clinical characteristics, were compared to those of patients presenting with hypertensive ICH and PRES. Results: Patients with hypertensive ICH (n=58) comprised the group with the oldest age, longest duration of hypertension and highest burden of vascular risk factors, while the PRES group (n=9) signified the youngest group with short duration of hypertension and minimum number of vascular risk factors. The neurologically asymptomatic hypertensive crisis group (n=51) showed an intermediary phenotype not only with respect to these clinical characteristics, but also in terms of small vessel disease features. Multivariate analyses revealed advanced age (p=0.009), cerebral microbleeds (p<0.001) and small vessel disease burden (p=0.019) to be related with cerebral hemorrhage rather than asymptomatic hypertensive crisis or PRES. Conclusion: The clinical phenotype in the setting of an acute hypertensive episode depends on specific clinical and imaging features. PRES occurs in young brains not accustomed to chronic hypertension, while the episode results in ICH in old patients with a high small vessel disease burden and remains asymptomatic among patients devoid of such characteristics.

scholarly journals Left Ventricular Hypertrophy and Cerebral Small Vessel Disease: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 22 (2) ◽  
pp. 206-224
Author(s):  
Andreas Papadopoulos ◽  
Konstantinos Palaiopanos ◽  
Athanasios P. Protogerou ◽  
George P. Paraskevas ◽  
Georgios Tsivgoulis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ventricular Hypertrophy ◽  
Population Studies ◽  
Small Vessel Disease ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Cerebral Small Vessel Disease ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Vessel Disease

Background and Purpose Left ventricular hypertrophy (LVH) is associated with the risk of stroke and dementia independently of other vascular risk factors, but its association with cerebral small vessel disease (CSVD) remains unknown. Here, we employed a systematic review and meta-analysis to address this gap.<br/>Methods Following the MOOSE guidelines (PROSPERO protocol: CRD42018110305), we systematically searched the literature for studies exploring the association between LVH or left ventricular (LV) mass, with neuroimaging markers of CSVD (lacunes, white matter hyperintensities [WMHs], cerebral microbleeds [CMBs]). We evaluated risk of bias and pooled association estimates with random-effects meta-analyses.<br/>Results We identified 31 studies (n=25,562) meeting our eligibility criteria. In meta-analysis, LVH was associated with lacunes and extensive WMHs in studies of the general population (odds ratio [OR]lacunes, 1.49; 95% confidence interval [CI], 1.12 to 2.00) (ORWMH, 1.73; 95% CI, 1.38 to 2.17) and studies in highrisk populations (ORlacunes: 2.39; 95% CI, 1.32 to 4.32) (ORWMH, 2.01; 95% CI, 1.45 to 2.80). The results remained stable in general population studies adjusting for hypertension and other vascular risk factors, as well as in sub-analyses by LVH assessment method (echocardiography/electrocardiogram), study design (cross-sectional/cohort), and study quality. Across LV morphology patterns, we found gradually increasing ORs for concentric remodelling, eccentric hypertrophy, and concentric hypertrophy, as compared to normal LV geometry. LVH was further associated with CMBs in high-risk population studies.<br/>Conclusions LVH is associated with neuroimaging markers of CSVD independently of hypertension and other vascular risk factors. Our findings suggest LVH as a novel risk factor for CSVD and highlight the link between subclinical heart and brain damage.

Sign in / Sign up

Export Citation Format

Share Document