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 W MP58: The Relationship Between Carotid Stiffness, Diastolic Diameter, and White Matter Hyperintensity Volume: The Northern Manhattan Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Matthew S Markert ◽  
Chuanhui Dong ◽  
David Della-Morte ◽  
Eugene Roberts ◽  
Susanne Bartels ◽  
...  
Keyword(s):  
Risk Factors ◽  
White Matter ◽  
Small Vessel Disease ◽  
Vascular Risk Factors ◽  
Small Vessel ◽  
White Matter Hyperintensity ◽  
Large Artery ◽  
Vascular Risk ◽  
Vessel Disease ◽  
Carotid Stiffness

Background: Changes in the extracranial vasculature may be associated with small vessel disease in the brain. We sought to examine the association of carotid stiffness and carotid diastolic diameter with white matter hyperintensity volume (WMHV), a magnetic resonance imaging (MRI) measure for cerebral small vessel disease, in a multi-ethnic community-based cohort. Methods: We evaluated 1140 stroke-free participants in the Northern Manhattan study who underwent brain MRIs and high-resolution carotid ultrasounds. We used linear regression to examine carotid stiffness and diastolic diameter with WMHV after adjusting for sociodemographics, lifestyle behaviors, and traditional vascular risk factors. Results: Among 1140 participants (mean age: 70.6±9.0 years; 61% women; 15% White, 16% Black, 59% Hispanics), the mean carotid stiffness was 8.19 ± 5.39, mean carotid diastolic diameter was 6.16 ± 0.93 mm, and mean WMHV 0.68 ± 0.84. In a fully adjusted model, diastolic diameter was associated with log-WMHV (β=0.10, p=0.001). In a stratified multivariable linear model, greater carotid arterial stiffness and diastolic diameter were associated with log-WMHV among Hispanics (β=0.15, p=0.005 and β=0.13, p<0.001, respectively), but not among blacks or whites. Conclusion: Greater carotid stiffness and diastolic diameter were associated with greater WMHV independent of demographics and traditional vascular risk factors, especially among Hispanics. Further studies are needed to understand how these large artery characteristics relate to WMH formation and lesion load. Carotid ultrasound may be a useful tool to assess the risk of increased brain white matter disease in a pre-clinical stage.

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 Carotid artery wall stiffness is increased in patients with small vessel disease: A case-control study

2016 ◽  
Vol 144 (1-2) ◽  
pp. 6-9 ◽  
Author(s):  
Denisa Salihovic-Hajdarevic ◽  
Aleksandra Pavlovic ◽  
Dzevdet Smajlovic ◽  
Ana Podgorac ◽  
Zagorka Jovanovic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Carotid Artery ◽  
Arterial Stiffness ◽  
Small Vessel Disease ◽  
Vascular Risk Factors ◽  
Small Vessel ◽  
Vascular Risk ◽  
Vessel Disease ◽  
Increased Risk ◽  
Atheromatous Plaques

Introduction. Cerebral ischemic small-vessel disease (SVD), causing lacunar infarcts and white matter hyperintensities on brain magnetic resonance imaging (MRI), is a progressive disease associated with an increased risk of stroke, dementia and death. Increased arterial stiffness has been associated with ischemic stroke and cerebral SVD independently of common vascular risk factors. Objective. The aim of the study was to analyze arterial stiffness in our patients with symptomatic SVD. Methods. In a cross-sectional study design we included 30 patients with clinical and MRI evidence of cerebral SVD and 30 age-, gender- and risk factor-matched control subjects with no neurological diseases. Patients were evaluated at the Ultrasound Laboratory at the Neurology Clinic, Clinical Center of Serbia in Belgrade, during a three-month period (from September 1st to December 1st 2012). Baseline demographic and vascular risk factors were recorded. All patients underwent standard carotid ultrasound scans with measuring of intima-media thickness (IMT) and analysis of atheromatous plaques. Internal carotid artery stiffness was evaluated with the use of e-tracking option as beta stiffness index (BSI) value. Results. There were no differences between study groups in regard to degree of carotid stenosis and type of carotid plaques (p>0.05). Patients in SVD group had significantly higher mean IMT (p=0.0093) and mean BSI (p<0.0001) than subjects in the control group. No significant correlation was detected between IMT and BSI in SVD group (r=0.168; p=0.376). Brain lesions severity correlated with BSI (r=0.733; p<0.0001). Conclusion. Arterial stiffness is increased in symptomatic patients with SVD, independently of vascular risk factors and IMT.

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.

Abstract T P412: Cerebral Microbleeds and Cognition: The Framingham Heart Study

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jose R Romero ◽  
Sarah R Preis ◽  
Alexa Beiser ◽  
Ashkan Shoamanesh ◽  
Rhoda Au ◽  
...  
Keyword(s):  
Risk Factors ◽  
Executive Function ◽  
Cognitive Performance ◽  
Small Vessel Disease ◽  
Vascular Risk Factors ◽  
Cerebral Microbleeds ◽  
Small Vessel ◽  
Vascular Risk ◽  
Community Based ◽  
Vessel Disease

Objective: To study the association of cerebral microbleeds (CMB) on MRI and performance on a comprehensive neuropsychological test battery in a community based cohort free of stroke and dementia. Background: CMB represent hemorrhage-prone cerebral small vessel disease (SVD) and have been related to increased risk of dementia. In non-demented individuals, CMB may negatively affect cognition and the pattern of impaired cognitive performance may differ according to lesion topography. Methods: We evaluated 1744 Framingham Offspring Study participants (mean age 64.6 years, 54% women) attending a baseline examination (1998-2008), who had brain MRI allowing for CMB detection and underwent concurrent NP testing. Using multivariable linear regression we related CMB presence overall and stratified by brain location (lobar, deep or mixed) to performance on NP tests representing cognitive domains including memory, executive function, abstraction, language and visuospatial function. Results: CMB were observed in 7.7% of subjects (66% lobar, 20% deep, 14% mixed). After adjustment for sex, age, level of education and MRI markers of ischemic small vessel disease, presence of any CMB was associated with impaired performance on tests of abstraction (β -0.71, p=0.02) and language (β -0.13, p=0.04). The associations were attenuated after adjustment for vascular risk factors (hypertension, diabetes, smoking, prevalent cardiovascular disease). Lobar CMB showed similar marginal associations (p=0.05), also attenuated after adjustment for vascular risk factors. Mixed location CMB were associated with tests of executive function, an association that remained significant after adjustment for MRI markers of ischemic SVD and vascular risk factors (β-0.12, p= 0.02). CMB in only deep location did not show any significant association with NP test performance. Conclusions: CMB were associated with lower cognitive performance in a community-based sample of middle-aged adults. Our findings are limited given the cross sectional study design and small sample in subgroups of deep and mixed CMB, but concur with studies suggesting a negative impact of CMB on cognition, and expand prior studies by showing that the relations are independent of ischemic cerebral SVD.

scholarly journals Perivascular spaces on 7 Tesla brain MRI are related to markers of small vessel disease but not to age or cardiovascular risk factors

2016 ◽  
Vol 36 (10) ◽  
pp. 1708-1717 ◽  
Author(s):  
Willem H Bouvy ◽  
Jaco JM Zwanenburg ◽  
Rik Reinink ◽  
Laura EM Wisse ◽  
Peter R Luijten ◽  
...  
Keyword(s):  
Risk Factors ◽  
Basal Ganglia ◽  
Small Vessel Disease ◽  
Brain Mri ◽  
Vascular Risk Factors ◽  
Small Vessel ◽  
7 Tesla ◽  
Perivascular Spaces ◽  
Vascular Risk ◽  
Vessel Disease

Cerebral perivascular spaces (PVS) are small physiological structures around blood vessels in the brain. MRI visible PVS are associated with ageing and cerebral small vessel disease (SVD). 7 Tesla (7T) MRI improves PVS detection. We investigated the association of age, vascular risk factors, and imaging markers of SVD with PVS counts on 7 T MRI, in 50 persons aged ≥ 40. The average PVS count ± SD in the right hemisphere was 17 ± 6 in the basal ganglia and 71 ± 28 in the semioval centre. We observed no relation between age or vascular risk factors and PVS counts. The presence of microbleeds was related to more PVS in the basal ganglia (standardized beta 0.32; p = 0.04) and semioval centre (standardized beta 0.39; p = 0.01), and white matter hyperintensity volume to more PVS in the basal ganglia (standardized beta 0.41; p = 0.02). We conclude that PVS counts on 7T MRI are high and are related SVD markers, but not to age and vascular risk factors. This latter finding may indicate that due to the high sensitivity of 7T MRI, the correlation of PVS counts with age or vascular risk factors may be attenuated by the detection of “normal”, non-pathological PVS.

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