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1.
Chinese Medical Journal ; (24): 2992-2998, 2021.
Article in English | WPRIM | ID: wpr-921252

ABSTRACT

BACKGROUND@#Single subcortical infarction (SSI) is caused by two main etiological subtypes, which are branch atheromatous disease (BAD) and cerebral small vessel disease (CSVD)-related SSI. We applied the Beijing version of the Montreal Cognitive Assessment (MoCA-BJ), the Shape Trail Test (STT), and the Stroop Color and Word Test (SCWT) to investigate the differences in cognitive performance between these two subtypes of SSI.@*METHODS@#Patients with acute SSIs were prospectively enrolled. The differences of MoCA-BJ, STT, and SCWT between the BAD group and CSVD-related SSI group were analyzed. A generalized linear model was used to analyze the associations between SSI patients with different etiological mechanisms and cognitive function. We investigated the correlations between MoCA-BJ, STT, and SCWT using Spearman's correlation analysis and established cut-off scores for Shape Trail Test A (STT-A) and STT-B to identify cognitive impairment in patients with SSI.@*RESULTS@#This study enrolled a total of 106 patients, including 49 and 57 patients with BAD and CSVD-related SSI, respectively. The BAD group performances were worse than those of the CSVD-related SSI group for STT-A (83 [60.5-120.0] vs. 68 [49.0-86.5], P = 0.01), STT-B (204 [151.5-294.5] vs. 153 [126.5-212.5], P = 0.015), and the number of correct answers on Stroop-C (46 [41-49] vs. 49 [45-50], P = 0.035). After adjusting for age, years of education, National Institutes of Health Stroke Scale and lesion location, the performance of SSI patients with different etiological mechanisms still differed significantly for STT-A and STT-B.@*CONCLUSIONS@#BAD patients were more likely to perform worse than CSVD-related SSI patients in the domains of language, attention, executive function, and memory. The mechanism of cognitive impairment after BAD remains unclear.


Subject(s)
Cerebral Infarction , Cerebral Small Vessel Diseases , Cognitive Dysfunction/etiology , Executive Function , Humans , Mental Status and Dementia Tests
2.
Chinese Medical Journal ; (24): 143-150, 2021.
Article in English | WPRIM | ID: wpr-878017

ABSTRACT

Age-related sporadic cerebral small vessel disease (CSVD) has gained increasing attention over the past decades because of its increasing prevalence associated with an aging population. The widespread application of and advances in brain magnetic resonance imaging in recent decades have significantly increased researchers' understanding in the in vivo evolution of CSVD, its impact upon the brain, its risk factors, and the mechanisms that explain the various clinical manifestation associated with sporadic CSVD. In this review, we aimed to provide an update on the pathophysiology, risk factors, biomarkers, and the determinants and spectrum of the clinical manifestation of sporadic CSVD.


Subject(s)
Aged , Aging , Brain/diagnostic imaging , Cerebral Small Vessel Diseases/epidemiology , Humans , Magnetic Resonance Imaging , Pandemics
3.
Article in Chinese | WPRIM | ID: wpr-878844

ABSTRACT

The purpose of the study is to analyze the outcomes of randomized controlled trial(RCT) of Chinese herbal medicine formula(CHMF) in the treatment of vascular cognitive impairment caused by cerebral small vessel disease(CSVD-VCI), and provide suggestions for future studies in this field. Three English databases, four Chinese databases, and two online registration websites of clinical trials were searched with use of the search strategy established in advance. Relevant RCTs published in recent ten years were screened, and necessary information was extracted to assess the risk of bias and analyze the outcomes of these RCTs. As a result, a total of 10 461 articles were retrieved, of which 8 681 were kept after de-duplication, and 41 RCTs were included after screening, with a generally higher risk of bias. The outcomes of included RCTs were classified into 9 categories, namely, clinical symptom outcomes, neuroimaging outcomes, neuroelectrophysiological outcomes, blood biochemical outcomes, hemorheology outcomes, physical signs, syndrome scores of traditional Chinese medicine(TCM), clinical effective rate, and safety outcomes. Among them, the most frequently reported outcomes of included RCTs were blood biochemical outcomes, and clinical symptom outcomes showed the highest reporting rate. Besides, 9 RCTs reported syndrome scores of TCM as the outcomes and illustrated corresponding evaluation criteria. The analysis showed that the application of RCT outcomes in this field had clinical rationality and limitations, and there were also some deficiencies in the trial design level, namely, no distinction between primary and secondary outcomes, insufficient blind methods, not detailed description of outcomes, disunity of evaluation tools, and despised endpoint outcomes. These limitations and deficiencies were negatively affecting the quality of RCTs of CHMF in the treatment of CSVD-VCI. Therefore, we suggest that future researchers should be well prepared in the top-level design stage, and actively construct the core outcome set of this field, so as to improve the quality of clinical trials.


Subject(s)
Cerebral Small Vessel Diseases , Cognitive Dysfunction , Drugs, Chinese Herbal , Humans , Medicine, Chinese Traditional , Phytotherapy
4.
Chinese Medical Journal ; (24): 151-160, 2020.
Article in English | WPRIM | ID: wpr-878025

ABSTRACT

The common cerebral small vessel disease (CSVD) neuroimaging features visible on conventional structural magnetic resonance imaging include recent small subcortical infarcts, lacunes, white matter hyperintensities, perivascular spaces, microbleeds, and brain atrophy. The CSVD neuroimaging features have shared and distinct clinical consequences, and the automatic quantification methods for these features are increasingly used in research and clinical settings. This review article explores the recent progress in CSVD neuroimaging feature quantification and provides an overview of the clinical consequences of these CSVD features as well as the possibilities of using these features as endpoints in clinical trials. The added value of CSVD neuroimaging quantification is also discussed for researches focused on the mechanism of CSVD and the prognosis in subjects with CSVD.


Subject(s)
Cerebral Small Vessel Diseases/diagnostic imaging , Humans , Magnetic Resonance Imaging , Neuroimaging , Prognosis
5.
Chinese Medical Journal ; (24): 178-184, 2020.
Article in English | WPRIM | ID: wpr-877896

ABSTRACT

BACKGROUND@#Homozygous or compound heterozygous mutations in high temperature requirement serine peptidase A1 (HTRA1) gene are responsible for cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL). Recently, increasing evidence has shown that heterozygous HTRA1 mutations are also associated with cerebral small vessel disease (CSVD) with an autosomal dominant pattern of inheritance. This study was aimed to analyze the genetic and clinical characteristics of HTRA1-related autosomal dominant CSVD.@*METHODS@#We presented three new Chinese cases of familial CSVD with heterozygous HTRA1 mutations and reviewed all clinical case reports and articles on HTRA1-related autosomal dominant CSVD included in PUBMED by the end of March 1, 2020. CARASIL probands with genetic diagnosis reported to date were also reviewed. The genetic and clinical characteristics of HTRA1-related autosomal dominant CSVD were summarized and analyzed by comparing with CARASIL.@*RESULTS@#Forty-four HTRA1-related autosomal dominant CSVD probands and 22 CARASIL probands were included. Compared with typical CARASIL, HTRA1-related autosomal dominant probands has a higher proportion of vascular risk factors (P < 0.001), a later onset age (P < 0.001), and a relatively slower clinical progression. Alopecia and spondylosis can be observed, but less than those in the typical CARASIL. Thirty-five heterozygous mutations in HTRA1 were reported, most of which were missense mutations. Amino acids located close to amino acids 250-300 were most frequently affected, followed by these located near 150∼200. While amino acids 250∼300 were also the most frequently affected region in CARASIL patients, fewer mutations precede the 200th amino acids were detected, especially in the Kazal-type serine protease domain.@*CONCLUSIONS@#HTRA1-related autosomal dominant CSVD is present as a mild phenotype of CARASIL. The trend of regional concentration of mutation sites may be related to the concentration of key sites in these regions which are responsible for pathogenesis of HTRA1-related autosomal dominant CSVD.


Subject(s)
Cerebral Infarction , Cerebral Small Vessel Diseases/genetics , Heterozygote , High-Temperature Requirement A Serine Peptidase 1/genetics , Humans , Leukoencephalopathies/genetics , Mutation/genetics
6.
Arq. neuropsiquiatr ; 77(5): 310-314, Jun. 2019. tab, graf
Article in English | LILACS | ID: biblio-1011347

ABSTRACT

ABSTRACT Objective: To investigate the predictive value of transcranial Doppler (TCD) ultrasound for cerebral small vessel disease in elderly patients. Methods: Transcranial Doppler ultrasound and magnetic resonance imaging (MRI) were performed on 184 elderly patients with cerebral small vessel disease. The relationship of clinical characteristics and TCD ultrasound parameters with severe white matter lesions (WMLs) in MRI were investigated by univariate analysis and multivariate analysis. Results: The univariate analysis showed that age, left middle cerebral artery (MCA) mean flow velocity, right MCA mean flow velocity and mean MCA pulsatility index were significantly correlated with severe WMLs (p < 0.05). The multivariate logistic regression analysis showed that only age (odds ratio: 1.21; 95%CI: 1.10-1.36; p < 0.01) and MCA pulsatility index (dominance ratio: 1.13; 95%CI: 1.06-1.80; p = 0.02) were significantly correlated with severe WMLs. The analysis of TCD ultrasound parameters showed that when the cut-off for MCA pulsatility index was 1.04, it could identify severe WMLs. The area under the curve was 0.70 (95%CI: 0.60-0.80). The sensitivity and specificity were 63.0% and 72.0%, respectively. The positive and negative predictive values were 35.4% and 86.6%, respectively. Conclusion: The MCA pulsatility index in TCD ultrasound is significantly correlated with severe WMLs; and TCD ultrasound can guide selective MRI for the detection of WMLs.


RESUMO Objetivo: Investigar o valor preditivo do ultrassom de Doppler transcraniano (TCD) para doença de pequenos vasos (SVD) em pacientes idosos. Métodos: ultrassonografia de TCD e ressonância magnética (RM) foram realizadas em 184 idosos portadores de SVD cerebral. As relações das características clínicas e os parâmetros ultrassonográficos do TCD com lesão grave de substância branca (WML) no desempenho da RM foram investigados por análise univariada e análise multivariada. Resultados: A análise univariada mostrou que, a idade, a velocidade média de fluxo (MFV) da artéria média cerebral (MCA) esquerda, a MFV da MCA direita e o índice de pulsatilidade (PI) médio estiveram significativamente relacionados à WML grave (P <0,05). A análise de regressão logística multivariada mostrou que apenas a idade (razão de chances: 1,21; IC95%: 1,10-1,36; P <0,01) e o PI da MCA (razão de dominância: 1,13; IC 95%: 1,06-1,80; P = 0,02) estiveram significativamente relacionados a WML grave. A análise dos parâmetros ultrassonográficos do TCD mostrou que, quando o ponto de corte do IP do MCA foi 1,04, ele pôde identificar à WML grave. A área sob a curva foi de 0,70 (IC 95%: 0,60-0,80). A sensibilidade e especificidade foram de 63,0% e 72,0%, respectivamente. Os valores preditivos positivos e negativos foram de 35,4% e 86,6%, respectivamente. Conclusão: O PI da MCA na ultrassonografia do TCD está significativamente relacionado à WML grave. A ultrassonografia TCD pode orientar a ressonância magnética seletiva para detecção da WML.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Magnetic Resonance Imaging/methods , Ultrasonography, Doppler, Transcranial/methods , Cerebral Small Vessel Diseases/diagnostic imaging , Reference Values , Severity of Illness Index , Pulsatile Flow , Logistic Models , Multivariate Analysis , Predictive Value of Tests , Reproducibility of Results , Middle Cerebral Artery/physiopathology
7.
Journal of Stroke ; : 121-138, 2019.
Article in English | WPRIM | ID: wpr-766253

ABSTRACT

Cerebral small vessel disease (CSVD) is a common group of neurological conditions that confer a significant burden of morbidity and mortality worldwide. In most cases, CSVD is only recognized in its advanced stages once its symptomatic sequelae develop. However, its significance in asymptomatic healthy populations remains poorly defined. In population-based studies of presumed healthy elderly individuals, CSVD neuroimaging markers including white matter hyperintensities, lacunes, cerebral microbleeds, enlarged perivascular spaces, cortical superficial siderosis, and cerebral microinfarcts are frequently detected. While the presence of these imaging markers may reflect unique mechanisms at play, there are likely shared pathways underlying CSVD. Herein, we aim to assess the etiology and significance of these individual biomarkers by focusing in asymptomatic populations at an epidemiological level. By primarily examining population-based studies, we explore the risk factors that are involved in the formation and progression of these biomarkers. Through a critical semi-systematic review, we aim to characterize “asymptomatic” CSVD, review screening modalities, and draw associations from observational studies in clinical populations. Lastly, we highlight areas of research (including therapeutic approaches) in which further investigation is needed to better understand asymptomatic CSVD.


Subject(s)
Aged , Biomarkers , Cerebral Small Vessel Diseases , Epidemiology , Humans , Leukoaraiosis , Mass Screening , Mortality , Neuroimaging , Risk Factors , Siderosis , Stroke, Lacunar , White Matter
8.
Yonsei Medical Journal ; : 774-781, 2019.
Article in English | WPRIM | ID: wpr-762107

ABSTRACT

PURPOSE: Cerebral small vessel disease (SVD) is known to be associated with ischemic stroke, intracerebral hemorrhage (ICH), and cognitive impairment. In this retrospective observational study, we explored SVD markers on MRI relevant to spontaneous ICH. MATERIALS AND METHODS: The ICH group consisted of 150 consecutive patients with a first primary parenchymal ICH, and the control group consisted of 271 age- and sex-matched individuals who underwent brain MRI in a health care center. We compared cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), enlarged perivascular space (EPVS), and lacunae in the ICH and control groups. RESULTS: A total of 1278 CMB lesions were identified in 121 of the 150 patients in the ICH group (80.6%), while 77 CMB lesions were found in 32 of the 271 individuals in the control group (11.8%). WMH and EPVS were more severe and lacunae were more frequent in the ICH patients than in the control group. When receiver operating characteristic (ROC) curves were plotted, number of CMBs most significantly predicted ICH. All imaging markers were significantly associated with ICH in every age group. The location of CMBs coincided with the location of ICH, and ICH volume correlated with CMB count. CONCLUSION: All MRI markers for SVD were worse in ICH patients than in healthy controls, and these markers were prominent even in young ICH patients. Lacunae, WMH, EPVS, and CMB should be considered as factors related with spontaneous ICH.


Subject(s)
Brain , Cerebral Amyloid Angiopathy , Cerebral Hemorrhage , Cerebral Small Vessel Diseases , Cognition Disorders , Delivery of Health Care , Humans , Hypertension , Intracranial Hemorrhages , Magnetic Resonance Imaging , Observational Study , Retrospective Studies , ROC Curve , Stroke , White Matter
9.
Article in English | WPRIM | ID: wpr-785690

ABSTRACT

BACKGROUND AND PURPOSE: Cerebral small vessel disease (CSVD) is the most common cause of vascular dementia and a major contributor to mixed dementia. CSVD is characterized by progressive cerebral white matter changes (WMC) due to chronic low perfusion and loss of autoregulation. In addition to its antiplatelet effect, cilostazol exerts a vasodilating effect and improves endothelial function. This study aims to compare the effects of cilostazol and aspirin on changes in WMC volume in CSVD.METHODS: The comparison study of Cilostazol and aspirin on cHAnges in volume of cerebral smaLL vEssel disease white matter chaNGEs (CHALLENGE) is a double blind, randomized trial involving 19 hospitals across South Korea. Patients with moderate or severe WMC and ≥ 1 lacunar infarction detected on brain magnetic resonance imaging (MRI) are eligible; the projected sample size is 254. Participants are randomly assigned to a cilostazol or aspirin group at a 1:1 ratio. Cilostazol slow release 200 mg or aspirin 100 mg are taken once daily for 2 years. The primary outcome measure is the change in WMC volume on MRI from baseline to 104 weeks. Secondary imaging outcomes include changes in the number of lacunes and cerebral microbleeds, fractional anisotropy and mean diffusivity on diffusion tensor imaging, and brain atrophy. Secondary clinical outcomes include all ischemic strokes, all vascular events, and changes in cognition, motor function, mood, urinary symptoms, and disability.CONCLUSIONS: CHALLENGE will provide evidence to support the selection of long-term antiplatelet therapy in CSVD.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01932203


Subject(s)
Anisotropy , Aspirin , Atrophy , Brain , Cerebral Small Vessel Diseases , Cognition , Dementia , Dementia, Vascular , Diffusion Tensor Imaging , Homeostasis , Humans , Korea , Magnetic Resonance Imaging , Outcome Assessment, Health Care , Perfusion , Sample Size , Stroke , Stroke, Lacunar , White Matter
10.
Journal of Stroke ; : 167-179, 2018.
Article in English | WPRIM | ID: wpr-714728

ABSTRACT

Intracerebral hemorrhage (ICH) and lacunar infarction (LI) are the major acute clinical manifestations of cerebral small vessel diseases (cSVDs). Hypertensive small vessel disease, cerebral amyloid angiopathy, and hereditary causes, such as Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL), constitute the three common cSVD categories. Diagnosing the underlying vascular pathology in these patients is important because the risk and types of recurrent strokes show significant differences. Recent advances in our understanding of the cSVD-related radiological markers have improved our ability to stratify ICH risk in individual patients, which helps guide antithrombotic decisions. There are general good-practice measures for stroke prevention in patients with cSVD, such as optimal blood pressure and glycemic control, while individualized measures tailored for particular patients are often needed. Antithrombotic combinations and anticoagulants should be avoided in cSVD treatment, as they increase the risk of potentially fatal ICH without necessarily lowering LI risk in these patients. Even when indicated for a concurrent pathology, such as nonvalvular atrial fibrillation, nonpharmacological approaches should be considered in the presence of cSVD. More data are emerging regarding the presentation, clinical course, and diagnostic markers of hereditary cSVD, allowing accurate diagnosis, and therefore, guiding management of symptomatic patients. When suspicion for asymptomatic hereditary cSVD exists, the pros and cons of prescribing genetic testing should be discussed in detail in the absence of any curative treatment. Recent data regarding diagnosis, risk stratification, and specific preventive approaches for both sporadic and hereditary cSVDs are discussed in this review article.


Subject(s)
Anticoagulants , Atrial Fibrillation , Blood Pressure , CADASIL , Cerebral Amyloid Angiopathy , Cerebral Hemorrhage , Cerebral Small Vessel Diseases , Diagnosis , Genetic Testing , Humans , Pathology , Stroke , Stroke, Lacunar
11.
Journal of Stroke ; : 228-238, 2018.
Article in English | WPRIM | ID: wpr-714417

ABSTRACT

BACKGROUND AND PURPOSE: Neurofilament light chain (NfL) is a blood marker for neuroaxonal damage. We assessed the association between serum NfL and cerebral small vessel disease (SVD), which is highly prevalent in elderly individuals and a major cause of stroke and vascular cognitive impairment. METHODS: Using a cross-sectional design, we studied 53 and 439 patients with genetically defined SVD (Cerebral Autosomal-Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy [CADASIL]) and sporadic SVD, respectively, as well as 93 healthy controls. Serum NfL was measured by an ultrasensitive single-molecule array assay. We quantified magnetic resonance imaging (MRI) markers of SVD, i.e., white matter hyperintensity volume, lacune volume, brain volume, microbleed count, and mean diffusivity obtained from diffusion tensor imaging. Clinical characterization included neuropsychological testing in both SVD samples. CADASIL patients were further characterized for focal neurological deficits (National Institutes of Health stroke scale [NIHSS]) and disability (modified Rankin scale [mRS]). RESULTS: Serum NfL levels were elevated in both SVD samples (P < 1e-05 compared with controls) and associated with all SVD MRI markers. The strongest association was found for mean diffusivity (CADASIL, R2=0.52, P=1.2e-09; sporadic SVD, R2=0.21, P < 1e-15). Serum NfL levels were independently related to processing speed performance (CADASIL, R2=0.27, P=7.6e-05; sporadic SVD, R2=0.06, P=4.8e-08), focal neurological symptoms (CADASIL, NIHSS, P=4.2e-05) and disability (CADASIL, mRS, P=3.0e-06). CONCLUSIONS: We found serum NfL levels to be associated with both imaging and clinical features of SVD. Serum NfL might complement MRI markers in assessing SVD burden. Importantly, SVD needs to be considered when interpreting serum NfL levels in the context of other age-related diseases.


Subject(s)
Academies and Institutes , Aged , Biomarkers , Brain , CADASIL , Cerebral Small Vessel Diseases , Cognition Disorders , Complement System Proteins , Dementia, Vascular , Diffusion Tensor Imaging , Humans , Intermediate Filaments , Leukoencephalopathies , Magnetic Resonance Imaging , Neuropsychological Tests , Stroke , White Matter
12.
Journal of Stroke ; : 239-246, 2018.
Article in English | WPRIM | ID: wpr-714416

ABSTRACT

BACKGROUND AND PURPOSE: Epidemiological data of cerebral small vessel disease (CSVD) in the general population of China are lacking. We report on the prevalence of lacunes, white matter hyperintensity (WMH), and cerebral microbleeds (CMBs) in a community-based sample in China and compare the results with those of other studies. METHODS: This was a cross-sectional analysis of the population-based Shunyi Study in China. A total of 1,211 stroke-free participants (mean age, 55.6±9.3 years; 37.4% men) with available 3 Tesla (3T) magnetic resonance images were included in this analysis. Demographic information and risk factor data were assessed. The overall and age-specific prevalence of lacunes, WMH, and CMBs was evaluated. Associations between cardiovascular risk factors and the presence of these lesions were analyzed by multiple logistic regression. RESULTS: Our study showed a prevalence of 14.5% for lacunes, 72.1% for periventricular hyperintensity (PVH), 65.4% for deep white matter hyperintensity (DWMH), and 10.6% for CMBs. When compared with other community-based samples, individuals in the same age group showed a higher burden of lacunes and a relatively lower prevalence of CMBs. Advanced age was independently associated with the prevalence of these CSVD markers, while the presence of hypertension increased the risk of lacunes, PVH/DWMH, and CMBs in deep or infratentorial locations. CONCLUSIONS: A higher burden of lacunes but a relatively lower prevalence of CMBs was observed in this Chinese population. This notable result highlights the challenge of CSVD prevention in China. Chinese have a risk factor profile for CSVD similar to those in other populations.


Subject(s)
Asian Continental Ancestry Group , Cerebral Small Vessel Diseases , China , Cross-Sectional Studies , Humans , Hypertension , Logistic Models , Prevalence , Risk Factors , White Matter
13.
Article in English | WPRIM | ID: wpr-717131

ABSTRACT

BACKGROUND AND PURPOSE: Prospective memory (PM) has a known relationship with frontal function, and PM decline has been observed in amnestic mild cognitive impairment (aMCI). Cerebral small vessel disease, as evidenced by white matter hyperintensities (WMHs), is linked to frontal dysfunction. This study was undertaken to evaluate the relationship between PM decline and WMHs in patients with aMCI. METHODS: Of 74 enrollees with aMCI, 69 completed this prospective study. We compared total scores and sub-scores of the Prospective and Retrospective Memory Questionnaire (PRMQ) administered at baseline and 3 months later, stratifying patients by degree of WMHs. RESULTS: A significant decline was seen in PRMQ total scores and PM scores at the 3-month mark in patients with moderate (vs. mild) degrees of WMHs (−2.8±7.2 vs. 0.2±7.1; p=0.032). In addition, patients with moderate (vs. mild) degrees of deep WMHs (DWMHs) showed greater PM decline, whereas PM loss in patients with mild, moderate, or severe degrees of periventricular WMHs (PVWMHs) did not differ significantly. CONCLUSIONS: Findings of this study indicate that the burden of WMHs is consistently implicated in PM deterioration experienced by patients with aMCI, and signifies greater PM decline, especially in instances of extensive DWMHs. Greater attention to the change of PM is therefore needed in aMCI patients with WMHs.


Subject(s)
Cerebral Small Vessel Diseases , Humans , Memory , Memory, Episodic , Cognitive Dysfunction , Prospective Studies , Retrospective Studies , White Matter
14.
Journal of Stroke ; : 302-320, 2018.
Article in English | WPRIM | ID: wpr-716866

ABSTRACT

Cerebral small vessel disease (cSVD) has a crucial role in lacunar stroke and brain hemorrhages and is a leading cause of cognitive decline and functional loss in elderly patients. Based on underlying pathophysiology, cSVD can be subdivided into amyloidal and non-amyloidal subtypes. Genetic factors of cSVD play a pivotal role in terms of unraveling molecular mechanism. An important pathophysiological mechanism of cSVD is blood-brain barrier leakage and endothelium dysfunction which gives a clue in identification of the disease through circulating biological markers. Detection of cSVD is routinely carried out by key neuroimaging markers including white matter hyperintensities, lacunes, small subcortical infarcts, perivascular spaces, cerebral microbleeds, and brain atrophy. Application of neural networking, machine learning and deep learning in image processing have increased significantly for correct severity of cSVD. A linkage between cSVD and other neurological disorder, such as Alzheimer’s and Parkinson’s disease and non-cerebral disease, has also been investigated recently. This review draws a broad picture of cSVD, aiming to inculcate new insights into its pathogenesis and biomarkers. It also focuses on the role of deep machine strategies and other dimensions of cSVD by linking it with several cerebral and non-cerebral diseases as well as recent advances in the field to achieve sensitive detection, effective prevention and disease management.


Subject(s)
Aged , Amyloid , Atrophy , Biomarkers , Blood-Brain Barrier , Brain , Cerebral Small Vessel Diseases , Disease Management , Endothelium , Humans , Intracranial Hemorrhages , Learning , Machine Learning , Nervous System Diseases , Neuroimaging , Stroke, Lacunar , White Matter
15.
Dement. neuropsychol ; 11(4): 336-342, Oct,-Dec. 2017. graf
Article in English | LILACS | ID: biblio-891033

ABSTRACT

ABSTRACT. In recent years, small vessel disease (SVD) has been recognized for its major impact on cognitive impairment in elderly people, where it is often difficult to separate its effects from those of neurodegenerative diseases individually. SVD is a systemic disease, probably related to diffuse endothelial dysfunction, which affects the perforating arterioles, capillaries and venules in the brain. Although often asymptomatic, it is responsible for almost half of all dementia cases and a significant proportion of stroke cases. Imaging features found on magnetic resonance include recent small subcortical infarctions, lacunes of presumed vascular origin, white matter hyperintensity of presumed vascular origin, prominent perivascular spaces and cerebral microbleeds. The recognition of these imaging findings as a spectrum of the same disease caused by endothelial dysfunction of small cerebral vessels can allow an overall analysis of the disease and thus the development of more effective preventive and therapeutic strategies.


RESUMO. Nos últimos anos, a doença de pequenos vasos cerebrais (DPV) tem sido reconhecida por seu grande impacto no comprometimento cognitivo em pacientes mais velhos, sendo muitas vezes difícil separar os efeitos dela e das doenças neurodegenerativas individualmente. Trata-se de uma doença sistêmica, provavelmente relacionada com uma disfunção endotelial difusa, que no encéfalo acomete preferencialmente as arteríolas perfurantes, capilares e vênulas. Apesar de muitas vezes ser assintomática, é responsável por quase metade dos casos de demência e por uma parcela importante dos acidentes vasculares encefálicos. Os achados de neuroimagem encontrados na ressonância magnética incluem pequenos infartos subcorticais recentes, lacunas de origem vascular presumida, hipersinal da substância branca de origem vascular presumida, alargamento dos espaços perivasculares e micro-hemorragias. O reconhecimento desses achados de imagem como espectro de uma mesma doença ocasionada pela disfunção endotelial dos pequenos vasos cerebrais possivelmente permitirá uma análise global da doença e com isso o desenvolvimento de estratégias preventivas e terapêuticas mais eficazes.


Subject(s)
Humans , Magnetic Resonance Spectroscopy , Cerebral Small Vessel Diseases , Neuroimaging
16.
Article in Korean | WPRIM | ID: wpr-47051

ABSTRACT

BACKGROUND: Cerebral microbleeds (CMBs) reflect cerebral small vessel disease and has a pathological role in Alzheimer's disease (AD) and stroke according to their distribution. We investigated to determine whether association of CMBs distribution in Korean patients with AD and cerebral infarction by susceptibility weighted imaging (SWI) which is a most sensitive magnetic resonance imaging technique for enhanced detection and localization of CMBs. METHODS: Seventy-one patients (AD 30, recent cerebral infarction 21, control 20) were included and 1.5 Tesla SWI was used to image. The Microbleed Anatomical Rating Scale (MARS) was used to localize each CMBs distribution (lobar versus basal ganglia/thalamus [deep], and infratentorial). RESULTS: The prevalence of CMBs was higher in AD and cerebral infarction than controls (p=0.004). Predilection of the total CMBs (n=71) were in order of lobar, basal ganglia/thalamus (deep), and infratentorial region (p=0.029). There was only significant predilection of CMBs in basal ganglia/thalamus (deep) region in cerebral infarction compared with AD (p=0.037) and controls (p=0.011). However, predilection of CMBs in lobar region than infratentorial region (p=0.019) in AD, and predilection of CMBs in basal ganglia/thalamus (deep) region than infratentorial region (p=0.033) in cerebral infarction were significant. Hypertension, a strong risk factor for hypertensive angiopathy was not significant in contributing CMBs prevalence in three groups even though the incidence of hypertension was higher in cerebral infarction than AD and controls. CONCLUSION: Characteristic predilection pattern of CMBs distribution between AD and cerebral infarction through SWI might provide an imaging biomarker for differentiation between dementia due to cerebrovascular disease and cerebral degenerative disorders.


Subject(s)
Alzheimer Disease , Cerebral Infarction , Cerebral Small Vessel Diseases , Cerebrovascular Disorders , Dementia , Humans , Hypertension , Incidence , Magnetic Resonance Imaging , Prevalence , Risk Factors , Stroke
17.
Rev. neuropsiquiatr ; 79(3): 137-141, jul.-sept. 2016. tab
Article in Spanish | LIPECS, LILACS, LIPECS | ID: biblio-982934

ABSTRACT

Objetivos: las enfermedades cardiovasculares constituyen la principal causa de muerte en el mundo. Se ha identificadoa la hiperhomocisteinemia como uno de los factores de riesgo modificables para ésta enfermedad. El objetivo delestudio es determinar la asociación entre la hiperhomocisteinemia y la enfermedad cerebrovascular (ECV) porenfermedad de pequeños vasos (EPV). Material y Métodos: se incluyeron 101 historias clínicas de pacientes conECV admitidos durante 5 meses de manera consecutiva. Se excluyeron pacientes con ECV cardioembólica. Losinfartos se clasificaron en aquellos debidos a EPV y a otros subtipos de infarto no cardioembólico (NoEPV). Secompararon los niveles medios de homocisteína plasmática entre ambos grupos. Se estudió la relación entre losfactores de riesgo cardiovascular incluida la hiperhomocisteinemia; y la EPV a través de un análisis bivariadoy multivariado para factores de confusión.


Objectives: Hyperhomocysteinemia has been described as a risk factor for coronary disease and ischemic stroke. The aim of this paper is to determine the association between hyperhomocisteinemia and ischemic stroke caused by small vessels disease (SVD) in a group of non-cardioembolic stroke patients. Material and methods: One hundred and one clinical records of stroke patients admitted during 5 months were included. Stroke patients with a cardioembolic etiology were excluded. Stroke was classified into infarctions due to SVD and other non-cardioembolic infarctions (non-SVD) by using Adams criteria. We compared the levels of serum homocysteine between both groups using the “T student” test for independent samples. Bivariate and multivariate analyses for confounding factors were performed.


Subject(s)
Humans , Arteriosclerosis , Cerebral Small Vessel Diseases , Cerebrovascular Disorders , Hyperhomocysteinemia , Risk Factors , Epidemiology, Descriptive , Medical Records , Retrospective Studies
18.
Journal of Stroke ; : 312-320, 2016.
Article in English | WPRIM | ID: wpr-193772

ABSTRACT

BACKGROUND AND PURPOSE: Cerebral small vessel disease (SVDs) are related with large artery atherosclerosis. However, the association between aortic atheroma (AA) and cerebral small vessel disease has rarely been reported. This study evaluated the relationship between presence and burden of AAs and those of SVDs in patients with acute ischemic stroke. METHODS: We included 737 consecutive patients who underwent transesophageal echocardiography (TEE) and brain magnetic resonance imaging (MRI) for evaluation of acute stroke. AA subtypes were classified as complex aortic plaque (CAP) and simple aortic plaque (SAP). Presence and burden of SVDs including cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), perivascular spaces (PVSs), asymptomatic lacunar infarctions (ALIs), and total SVD score, were investigated. RESULTS: AA was found by TEE in 360 (48.8%) patients including 11.6% with CAP and 37.2% with SAP. One or more types of SVDs was found in 269 (36.4%) patients. In multivariable analysis, presence of CMBs (odds ratio [OR] 4.68), high-grade WMHs (OR 3.13), high-grade PVSs (OR 3.35), and ALIs (OR 4.24) were frequent in patients with AA than those without AA. Each 1-point increase in total SVD score increased the odds of presence of CAP (OR 1.94, 95% confidence interval (CI) 1.44-1.85) and SAP (OR 1.54, 95% CI 1.35-1.75). CONCLUSIONS: In this study, patients with AA frequently had cerebral SVDs. Larger burden of AA was associated with advanced cerebral SVDs. Our findings give an additional information for positive relationship with systemic atherosclerosis and coexisting cerebral SVDs in acute ischemic stroke patients.


Subject(s)
Arteries , Atherosclerosis , Brain , Cerebral Small Vessel Diseases , Echocardiography, Transesophageal , Humans , Magnetic Resonance Imaging , Plaque, Atherosclerotic , Stroke , Stroke, Lacunar , White Matter
19.
Article in English | WPRIM | ID: wpr-116051

ABSTRACT

BACKGROUND AND PURPOSE: Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most-common single gene disorder of cerebral small vessel disease. There is no definite evidence of genotype-phenotype correlation in CADASIL. However, recent studies have shown the unique phenotypic feature of NOTCH3 R544C mutation. METHODS: We investigated the phenotypic spectrum of NOTCH3 R544C mutation in 73 CADASIL patients in Jeju between April 2012 and January 2014. RESULTS: Of the 73 subjects from 60 unrelated families included in this study, 40 (55%) were men. The mean age of the subjects was 62.2±12.2 (range 34-86 years). Cerebral infarction was the most frequent manifestation (37%), followed by cognitive impairment (32%), headache (17%), psychiatric symptom (16%), intracerebral hemorrhage (12%), transient ischemic attack (7%), and seizure (1%). The mean age of the subjects with ischemic or hemorrhagic episodes was 64.9±10.9 (range 41-86 years). A diagnosis of dementia was made in 12 subjects (16%). The mean age of the subjects with dementia was 75.6±6.5 (range 62-86 years). About 3% of subjects were unable to walk without assistance at assessment. Only one subject had developed chronic headache before the 40s. CONCLUSIONS: Our data support the hypothesis that CADASIL patients with R544C mutation in Jeju have relatively late onset disease.


Subject(s)
CADASIL , Cerebral Hemorrhage , Cerebral Infarction , Cerebral Small Vessel Diseases , Dementia , Diagnosis , Genetic Association Studies , Genotype , Headache , Headache Disorders , Humans , Ischemic Attack, Transient , Leukoencephalopathies , Male , Phenotype , Seizures
20.
Article in English | WPRIM | ID: wpr-70776

ABSTRACT

BACKGROUND AND PURPOSE: Dilated Virchow-Robin spaces (dVRS) are not uncommon findings in the normal brain, particularly in the old people, and have been largely regarded as benign lesions. However, there is accumulating evidence that dVRS may serve as an neuroimaging marker of small vessel disease and are associated with cognitive decline. We investigated whether the severity of dVRS would be associated with cognitive dysfunction by comparing the subjects with subjective memory impairment (SMI), mild cognitive impairment (MCI), and Alzheimer's disease (AD). We also examined whether there were differences in the degree of correlation between dVRS and magnetic resonance imaging (MRI) markers of small vessel disease among the three groups. METHODS: In this retrospective study, a total of 225 subjects were included: those with SMI (n=65), MCI (n=100), and AD (n=60). We rated the severity of dVRS using the axial MRI slice containing the greatest number of dVRS in the basal ganglia (dVRS-BG) and in the deep white matter (dVRS-WM), separately. We also assessed baseline characteristics including vascular risk factors and MRI markers of small vessel disease such as white matter hyperintensities (WMH), lacunar infarcts and microbleeds. RESULTS: A cumulative logit model revealed that the severity of cognitive dysfunction was associated with age (p<0.001), hypertension (p=0.006), diabetes mellitus (p=0.042), the severity of dVRS-BG (p=0.001), the severity of WMH (p=0.074) and the presence of lacunar infarcts (p<0.001) and microbleeds (p=0.003) in univariate analysis. However, after adjusting for other confounding variables, the severity of dVRS-BG was not a significant discriminating factor among subjects with SMI, MCI, and AD. Spearman's correlation analysis showed a trend that the correlation between the severity of dVRS-BG and the severity of WMH became more prominent in subjects with AD than in those with MCI or SMI (r=0.191 in SMI; r=0.284 in MCI; r=0.312 in AD), and the same is true of the severity of dVRS-BG and the number of lacunar infarcts. CONCLUSIONS: The severity of dVRS was associated with cognitive dysfunction, which appeared to be confounded by other well-known risk factors. The correlation between dVRS-BG and small vessel disease markers tended to be more significant with the advancement of cognitive impairment. These results suggest that severe dVRS may reflect cerebral small vessel disease and contribute to cognitive impairment.


Subject(s)
Alzheimer Disease , Basal Ganglia , Brain , Cerebral Small Vessel Diseases , Cognition , Diabetes Mellitus , Hypertension , Logistic Models , Magnetic Resonance Imaging , Memory , Cognitive Dysfunction , Neuroimaging , Retrospective Studies , Risk Factors , Stroke, Lacunar
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