Possibilities of evaluating vascular risk

MRI and Doppler Sonography allow to study the effects of risk factors on brain parenchyma and vessels walls already in clinically silent stages of cerebrovascular disease and almost one third of normal volunteers reveal minimal to moderate carotid arterioclerosis at the presence of cerevasacular risk factors. However, it is yet unclear whether the detection of such abnormalities will also improve our predictive reliability in respect to the individual risk for stroke or vascular dementia. Basedon the similarity of white matter lesions with the MRI appearance of arteriosclerotic encephalopathy and neuropsychologic test results a tumely evolution of these changes towards dementia seems to be conceivable. Follow-up studies on the fate of white matter lesions will clarify, whether or not the appearence of such changes implies additional risk for vascular dementia than could be expected by the presence of risk factors alone. Serum fibrinogen has been indentified as the major predictor of extracranial arteriosclerosis in normals besides age. Increasing levels correlate with increasing probability of vessels wall damage. These data are of special interest since a previous study demostrate a higher risk for stroke and myocardial infarction in individuals with elevated serum fibrinogen levels than in those without. However. at the moment it can not be decided, if rheologic changes are the cause or sequence of vessels disease. Moreover future research has to determine, if serum fibrinogen increases the risk for stroke per se or may at least help to identify individuals at a high risk

The importance of MRI in stroke

It could be shown that MRI has capability of demostrating parenchymal damage due to cerebrovascular disease even in asymptomatic individuals. In ischemic stroke MRI is superior to CT because of the earlier detection of the lesion, a More precise delineation of lacunes, of brainstem infarcts, and of hemorrhagic components. Evidence of confluent white matter damage is helpful in differentiating vascualr dementia from degenerative forms. Is hemorrhagic stroke CT remains the preferred imaging technique during the acute phase but MRI will detect remnants of a cerebral hemorrhage for lifetime

Parkinson con alto riesgo hemodinámico / Parkinson with high haemodinamic risk

Dentro de los pacientes con enfermedad de Parkinson existen algunos que tienen especial frecuencia de factores de riesgo hemodinámico (hipertensión, diabetes, hipertrigliceridemia, agregación plaquetaria aumentada, disminución del flujo sanguíneo cerebral y anormalidades tomográficas). Estos pacientes tienen iguales síntomas que los demás, salvo en que los síntomas progresan más rápidamente. Es posible que una mejoría terapéutica de su estado vascular les sea útil