cerebrovascular pathology
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2022 ◽  
Vol 13 ◽  
Author(s):  
Atef Badji ◽  
Joana B. Pereira ◽  
Sara Shams ◽  
Johan Skoog ◽  
Anna Marseglia ◽  
...  

Background: Hypertension is an important risk factor for Alzheimer’s disease (AD). The pathophysiological mechanisms underlying the relationship between AD and hypertension are not fully understood, but they most likely involve microvascular dysfunction and cerebrovascular pathology. Although previous studies have assessed the impact of hypertension on different markers of brain integrity, no study has yet provided a comprehensive comparison of cerebrospinal fluid (CSF) biomarkers and structural brain differences between normotensive and hypertensive groups in a single and large cohort of older adults in relationship to cognitive performances.Objective: The aim of the present work was to investigate the differences in cognitive performances, CSF biomarkers and magnetic resonance imaging (MRI) of brain structure between normotensive, controlled hypertensive, uncontrolled hypertensive, and untreated hypertensive older adults from the Gothenburg H70 Birth Cohort Studies.Methods: As an indicator of vascular brain pathology, we measured white matter hyperintensities (WMHs), lacunes, cerebral microbleeds, enlarged perivascular space (epvs), and fractional anisotropy (FA). To assess markers of AD pathology/neurodegeneration, we measured hippocampal volume, temporal cortical thickness on MRI, and amyloid-β42, phosphorylated tau, and neurofilament light protein (NfL) in cerebrospinal fluid. Various neuropsychological tests were used to assess performances in memory, attention/processing speed, executive function, verbal fluency, and visuospatial abilities.Results: We found more white matter pathology in hypertensive compared to normotensive participants, with the highest vascular burden in uncontrolled participants (e.g., lower FA, more WMHs, and epvs). No significant difference was found in any MRI or CSF markers of AD pathology/neurodegeneration when comparing normotensive and hypertensive participants, nor among hypertensive groups. No significant difference was found in most cognitive functions between groups.Conclusion: Our results suggest that good blood pressure control may help prevent cerebrovascular pathology. In addition, hypertension may contribute to cognitive decline through its effect on cerebrovascular pathology rather than AD-related pathology. These findings suggest that hypertension is associated with MRI markers of vascular pathology in the absence of a significant decline in cognitive functions.


Stroke ◽  
2021 ◽  
Author(s):  
Lukas Sveikata ◽  
Andreas Charidimou ◽  
Anand Viswanathan

We review the implications of the recently approved aducanumab amyloid-β immunotherapy for treating Alzheimer disease with comorbid cerebral amyloid angiopathy. In clinical trials, amyloid-β immunotherapy has been associated with a high rate of amyloid-related imaging abnormalities, potentially driven by coexisting cerebral amyloid angiopathy. Therefore, immunotherapy’s efficacy in patients may be modified by coexisting cerebrovascular pathology. We discuss the contributions of cerebral amyloid angiopathy on the development of amyloid-related imaging abnormalities and propose strategies to identify cerebral amyloid angiopathy in patients considered for immunotherapy.


2021 ◽  
Vol 13 ◽  
Author(s):  
Nicole Lemon ◽  
Elisa Canepa ◽  
Marc A. Ilies ◽  
Silvia Fossati

The Neurovascular Unit (NVU) is an important multicellular structure of the central nervous system (CNS), which participates in the regulation of cerebral blood flow (CBF), delivery of oxygen and nutrients, immunological surveillance, clearance, barrier functions, and CNS homeostasis. Stroke and Alzheimer Disease (AD) are two pathologies with extensive NVU dysfunction. The cell types of the NVU change in both structure and function following an ischemic insult and during the development of AD pathology. Stroke and AD share common risk factors such as cardiovascular disease, and also share similarities at a molecular level. In both diseases, disruption of metabolic support, mitochondrial dysfunction, increase in oxidative stress, release of inflammatory signaling molecules, and blood brain barrier disruption result in NVU dysfunction, leading to cell death and neurodegeneration. Improved therapeutic strategies for both AD and stroke are needed. Carbonic anhydrases (CAs) are well-known targets for other diseases and are being recently investigated for their function in the development of cerebrovascular pathology. CAs catalyze the hydration of CO2 to produce bicarbonate and a proton. This reaction is important for pH homeostasis, overturn of cerebrospinal fluid, regulation of CBF, and other physiological functions. Humans express 15 CA isoforms with different distribution patterns. Recent studies provide evidence that CA inhibition is protective to NVU cells in vitro and in vivo, in models of stroke and AD pathology. CA inhibitors are FDA-approved for treatment of glaucoma, high-altitude sickness, and other indications. Most FDA-approved CA inhibitors are pan-CA inhibitors; however, specific CA isoforms are likely to modulate the NVU function. This review will summarize the literature regarding the use of pan-CA and specific CA inhibitors along with genetic manipulation of specific CA isoforms in stroke and AD models, to bring light into the functions of CAs in the NVU. Although pan-CA inhibitors are protective and safe, we hypothesize that targeting specific CA isoforms will increase the efficacy of CA inhibition and reduce side effects. More studies to further determine specific CA isoforms functions and changes in disease states are essential to the development of novel therapies for cerebrovascular pathology, occurring in both stroke and AD.


2021 ◽  
pp. 12-15
Author(s):  
S. G. Burchinsky

In the present paper a modern sights to manifestations of initial stages of brain ischemia and its role in damage of CNS in cerebrovascular pathology have been looked. Based on this point of view, the requirements to choice of optimal pharmacological strategy concerning correction of brain pathological changes during ischemia, and particularly neurometabolic pharmacotherapy’ advantages have been analyzed. A basic goals of clinical use of neuroprotection’s strategy in generally, and particularly neurometabolic pharmacotherapy have been looked. A main attention paid to mechanisms of action and peculiarities of clinical use of drug Dinar (ethyl-methyl-hydroxypiridine succinat) and its possibilities in plane to realization of pathogenetically grounding neurometabolic pharmacotherapy of initial stages of cerebrovascular pathology. A clinical efficacy of Dinar and its safety characteristics have been looked in detail.


2021 ◽  
Vol 26 (2) ◽  
pp. 97-104
Author(s):  
A.D. Shkodina ◽  
R.M. Grinko ◽  
I.I. Starchenko ◽  
N.I. Vynnyk ◽  
S.M. Sovhyria ◽  
...  

The role of human olfactory bulbs remains one of the most interesting questions concerning work of the brain, because this organ is one in which neurogenesis is continuously generated in post-natal and adult periods. Impaired sense of smell is not a pathology that threatens human life, therefore, often remains unnoticed. However, it can directly affect the quality of life, as it leads to malnutrition and certain problems in interpersonal relationships. The study of the functional structure of the olfactory analyzer plays an important role both in clinical and experimental studies, but the question of its features in humans needs detailed research. The material of the research was 18 pairs of the olfactory bulbs of males and females aged from 30 to 90 years that were received at the Poltava Regional Department of Pathology. In order to objectify the data obtained on micropreparations, the following morphometric indices were determined: the specific gravity of the location of cellular elements; the proportion of mitral neurocytes in the entire cell population; percentage ratio of relative quantity between cellular elements, blood microvessels, fibrillar component and homogeneous eosinophilic structures. Correlation analysis of morphometric indices in the general sample revealed the existence of an inverse communication of average strength between the relative number of homogeneous eosinophilic cells and the relative number of cellular elements and blood microvessels, which in turn indicates the etiopathogenetic mechanisms of the formation of these structures. The conducted research makes it possible to conclude that mitral cells as one of the most differentiated in olfactory bulbs are sensitive to the development of hypoxic states; under the conditions of cerebrovascular pathology, the relative amount of the blood vessels of the microvessels decreases, which leads to the disorder of the trophy of the nervous tissue and as a result can lead to neurocytolysis of mitral cells. Changes in the vascular and cellular com­ponent indicate a different pathogenesis of changes in human olfactory bulbs in these pathologies and suggest that eosinophilic homogeneous cells are the result of apoptotic neurocytolysis against the background of development of hypoxic states.


Author(s):  
С.А. Сайганов ◽  
В.И. Мазуров ◽  
В.В. Голдобин ◽  
С.В. Лобзин ◽  
Е.Г. Клочева ◽  
...  

В статье отражены перспективы оказания медицинской помощи пациентам пожилого и старческого возраста с цереброваскулярной патологией с использованием портативного телемедицинского комплекса. Проведен анализ телемедицинского взаимодействия врач-консультант-пациент для оказания медицинской помощи, обсуждены критерии выбора медицинских приборов в составе телемедицинского комплекса, организационно-правовые аспекты передачи, хранения и доступа к медицинской информации, приведены важные клинические особенности цереброваскулярной патологии у пациентов старших возрастных групп, определяющие необходимость привлечения высококвалифицированных специалистов, а также возможности использования разрабатываемого портативного комплекса. The article discusses perspectives of medical care in elderly and senile patients with cerebrovascular pathology with portable telemedical complex use. Analysis of telemedical cooperation physician-consultant-patient and discussion of medical equipment criteria for telemedical complex selection and organizational together with legal issues of medical data transfer, storage and access were performed. The important clinical features of cerebrovascular pathology in elderly patients were presented, which determined necessity of highly qualified medical specialist involvement in management of such patients. The opportunities of portable medical complex usage were discussed.


2021 ◽  
Author(s):  
Kaylene Gouveia-Freitas ◽  
António J. Bastos-Leite

AbstractPerivascular spaces (PVS) of the brain, often called Virchow-Robin spaces, comprise fluid, cells and connective tissue, and are externally limited by astrocytic endfeet. PVS are involved in clearing brain waste and belong to the “glymphatic” system and/or the “intramural periarterial drainage” pathway through the basement membranes of the arteries. Related brain waste clearance systems include the blood–brain barrier, scavenger cells, cerebrospinal fluid, perineural lymphatic drainage pathways and the newly characterised meningeal lymphatic vessels. Any functional abnormality of PVS or related clearance systems might lead to accumulation of brain waste. It has been postulated that PVS enlargement can be secondary to accumulation of β-amyloid. Lack of integrity of the vascular wall, microbleeds, cerebral amyloid angiopathy (CAA) and enlarged PVS often occur in the preclinical stages of Alzheimer’s disease, preceding substantial brain atrophy. PVS enlargement in the form of état criblé at the basal ganglia has also been considered to reflect focal atrophy, most probably secondary to ischaemic injury, based upon both pathological and imaging arguments. In addition, distinct topographic patterns of enlarged PVS are related to different types of microangiopathy: CAA is linked to enlarged juxtacortical PVS, whereas subjects with vascular risk factors tend to have enlarged PVS in the basal ganglia. Therefore, enlarged PVS are progressively being regarded as a marker of neurodegenerative and cerebrovascular pathology. The present review addresses the evolving concept of PVS and brain waste clearance systems, the potential relevance of their dysfunction to neurodegenerative and cerebrovascular pathology, and potential therapeutic approaches of interest.


2021 ◽  
Vol 2 (2(83)) ◽  
pp. 23-25
Author(s):  
A. Salmina ◽  
V. Levantsevich ◽  
D. Boris ◽  
T. Semak

The study is devoted to the study of the anatomy of the Willis circle of people with and without cerebral circulation pathology. We studied 243 angiograms (men and women of different age groups from 18 to 72 years old). Of these, 120 patients had no signs of cerebrovascular pathology, 123 patients had various kinds of cerebral circulation disorders. Only in 32% of cases, when studying 120 MR-angiograms of persons without cerebral circulation disorders, a classical type of structure of the arterial bed was revealed. In 68% of the subjects, structural anomalies were found, namely: 23% hypoplasia of the anterior communicating artery, 21% aplasia or hypoplasia of one of the posterior communicating arteries, 17% combination of aplasia of the anterior communicating arteries and aplasia of one of the posterior communicating arteries, 4% aplasia of the anterior and both posterior connecting arteries, 3% parietal contact of both anterior cerebral arteries. A study of the Willis circle of patients with cerebrovascular pathology revealed: 2% have a classic variant of the structure, 53% have aplasia of one of the posterior communicating arteries, aplasia of both posterior communicating arteries 26%, 19% a variant in which aplasia of the anterior and posterior communicating arteries is combined. Based on the foregoing, the classical type of structure of the arterial circle of the brain is the most optimal option for ensuring collateral blood flow.


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