Ambient air pollution, covert cerebrovascular disease and cognition: results from the ISSYS study.

BACKGROUND AND PURPOSE: Although air pollution (AP) has been associated with stroke and dementia, data regarding its relationship with covert cerebrovascular disease (cCVD) and cognition over time are sparse. The aim of this study was to explore these relationships. METHODS: A prospective population-based study of 976 stroke-free and non-demented individuals living in Barcelona, Spain, was conducted during 2010-2016. A land use regression model was used to estimate the exposure of each participant to AP: NOx, NO2, PM2.5, PM10, PMcoarse and PM2.5 absorbance. Cognitive function and cCVD were assessed at baseline (n = 976) and 4 years after (n = 317). Multivariate-adjusted models were developed. RESULTS: At baseline, 99 participants (10.1%) had covert brain infarcts and 91 (9.3%) had extensive periventricular white matter hyperintensities (WMHs). Marked subcortical WMH progression was seen in 19.7%; the incidence of other covert cerebrovascular lessons ranged between 5% and 6% each. PM2.5 was related to higher odds of having a covert brain infarct (odds ratio [OR] 2.21; 95% confidence interval [CI] 1.06-4.60). PM2.5 absorbance was related to higher odds of having extensive subcortical WMHs (OR 1.72; 95% CI 1.13-2.60), whereas NO2 was related to higher odds of having extensive subcortical (OR 1.66; 95% CI 1.17-2.35) or periventricular (OR 1.96; 95% CI 1.10-3.50) WMHs and to higher odds of developing marked subcortical WMH progression (OR 1.40; 95% CI 1.05-1.90). NOx was related to incident cerebral microbleeds (OR 1.36; 95% CI 1.04-1.79). There was no association between AP and cognition. CONCLUSIONS: Air pollutant predicts the presence and accumulation of cCVD. Its impact on cognitive impairment remains to be determined.

Medición semiautomática de la relación arteriovenosa retiniana como posible marcador de riesgo de infarto cerebral silente en pacientes hipertensos / Semi-automatic measuring of arteriovenous relation as a possible silent brain infarction risk index in hypertensive patients

PROPÓSITO: Evaluar la utilidad de un sistema semiautomático de medición de relación arteriovenosa (RAV) retiniana sobre imágenes retinográficas de pacientes hipertensos en la valoración del riesgo cardiovascular y la detección de isquemia cerebral silente (ICS). MÉTODO: Un total de 976 pacientes de la cohorte Investigating Silent Strokes in Hypertensives: a magnetic resonance imaging study (ISSYS) estudiados mediante resonancia magnética craneal para valorar la presencia o no de ICS fueron invitados a realizar una retinografía para un examen convencional de fondo de ojo y una medición semitautomática del promedio de los calibres vasculares para el cálculo de la relación arteriovenosa (RAV). RESULTADOS: Se analizaron las retinografías de 768 pacientes. Entre las lesiones observadas, solamente se encontró una asociación con la detección de ICS en aquellos pacientes con microaneurismas (OR: 2,50; IC 95%: 1,05-5,98) o una RAV alterada (<0,666) (OR: 4,22; IC 95%: 2,56-6,96). En el análisis de regresión logística multivariante ajustado por edad y sexo, solamente la RAV alterada continuó manifestándose como un factor de riesgo (OR: 3,70; IC 95%: 2,21-6,18). CONCLUSIONES: Los resultados muestran que el análisis semiautomático de la vasculatura retiniana a partir de retinografías tiene el potencial de ser considerado como un factor de riesgo vascular importante en la población hipertensa

OBJECTIVE: To evaluate the usefulness of a semiautomatic measuring system of arteriovenous relation (RAV) from retinographic images of hypertensive patients in assessing their cardiovascular risk and silent brain ischemia (ICS) detection. METHODS: Semi-automatic measurement of arterial and venous width were performed with the aid of Imedos software and conventional fundus examination from the analysis of retinal images belonging to the 976 patients integrated in the cohort Investigating Silent Strokes in Hypertensives: a magnetic resonance imaging study (ISSYS), group of hypertensive patients. All patients have been subjected to a cranial magnetic resonance imaging (RMN) to assess the presence or absence of brain silent infarct. RESULTS: Retinal images of 768 patients were studied. Among the clinical findings observed, association with ICS was only detected in patients with microaneurysms (OR 2.50; 95% CI: 1.05-5.98) or altered RAV (<0.666) (OR: 4.22; 95% CI: 2.56-6.96). In multivariate logistic regression analysis adjusted by age and sex, only altered RAV continued demonstrating as a risk factor (OR: 3.70; 95% CI: 2.21-6.18). CONCLUSIONS: The results show that the semiautomatic analysis of the retinal vasculature from retinal images has the potential to be considered as an important vascular risk factor in hypertensive population

Semi-automatic measuring of arteriovenous relation as a possible silent brain infarction risk index in hypertensive patients. / Medición semiautomática de la relación arteriovenosa retiniana como posible marcador de riesgo de infarto cerebral silente en pacientes hipertensos.

OBJECTIVE: To evaluate the usefulness of a semiautomatic measuring system of arteriovenous relation (RAV) from retinographic images of hypertensive patients in assessing their cardiovascular risk and silent brain ischemia (ICS) detection. METHODS: Semi-automatic measurement of arterial and venous width were performed with the aid of Imedos software and conventional fundus examination from the analysis of retinal images belonging to the 976 patients integrated in the cohort Investigating Silent Strokes in Hypertensives: a magnetic resonance imaging study (ISSYS), group of hypertensive patients. All patients have been subjected to a cranial magnetic resonance imaging (RMN) to assess the presence or absence of brain silent infarct. RESULTS: Retinal images of 768 patients were studied. Among the clinical findings observed, association with ICS was only detected in patients with microaneurysms (OR 2.50; 95% CI: 1.05-5.98) or altered RAV (<0.666) (OR: 4.22; 95% CI: 2.56-6.96). In multivariate logistic regression analysis adjusted by age and sex, only altered RAV continued demonstrating as a risk factor (OR: 3.70; 95% CI: 2.21-6.18). CONCLUSIONS: The results show that the semiautomatic analysis of the retinal vasculature from retinal images has the potential to be considered as an important vascular risk factor in hypertensive population.

Assessment of enlarged perivascular spaces and their relation to target organ damage and mild cognitive impairment in patients with hypertension.

BACKGROUND AND PURPOSE: Enlarged perivascular spaces (EPVS) have been recently considered a feature of cerebral small vessel disease. They have been related to aging, hypertension and dementia but their relationship with hypertension related variables (i.e. target organ damage, treatment compliance) and mild cognitive impairment (MCI) is not fully elucidated. Our aims were to investigate the relation between basal ganglia (BG) and centrum semiovale (CSO) EPVS with vascular risk factors, hypertension related variables and MCI. METHODS: In all, 733 hypertensive individuals free of stroke and dementia from the Investigating Silent Strokes in Hypertensives, a magnetic resonance imaging Study (ISSYS) underwent brain magnetic resonance imaging and cognitive testing to diagnose MCI or normal cognitive aging. RESULTS: The numbers of participants presenting high grade (>10) EPVS at the BG and CSO were 23.3% and 40.0%, respectively. After controlling for vascular risk factors, high grade BG EPVS were associated with age (odds ratio 1.68; 95% confidence interval 1.37, 2.06), poor antihypertensive compliance (1.49; 1.03, 2.14) and the presence of microalbuminuria (1.95; 1.16, 3.28), whereas in the CSO only age (1.38; 1.18, 1.63) and male sex were associated with EPVS (1.73; 1. 24, 2.42). MCI was diagnosed in 9.3% of the participants and it was predicted by EPVS in the BG (1.87; 1.03, 3.39) but not in the CSO. This last association was greatly attenuated after correction for lacunes and white matter hyperintensities. CONCLUSIONS: Basal ganglia EPVS are associated with the presence of microalbuminuria and poor adherence to antihypertensive drugs. The BG EPVS relation with MCI is not independent of the presence of other cerebral small vessel disease markers.

Blood and CSF biomarkers in brain subcortical ischemic vascular disease: Involved pathways and clinical applicability.

Vascular dementia is the second most common type of dementia after Alzheimer's disease (AD). Subcortical ischemic vascular disease refers to a form of vascular cognitive impairment characterized by the presence of diffuse white matter hyperintensities (WMHs) and multiple lacunar infarcts. These neuroimaging findings are mainly caused by cerebral small-vessel disease (cSVD) and relate to aging and cognitive impairment, but they can also be silent and highly prevalent in otherwise healthy individuals. We aimed to review studies on blood and cerebrospinal fluid (CSF) markers related to the presence of WMHs and lacunar infarcts that have been conducted in the past in large population-based studies and in high-risk selected patients (such as those with vascular risk factors, vascular cognitive impairment, or AD). Relevant associations with the presence and progression of cSVD have been described in the blood for markers related to inflammatory processes, endothelial damage and coagulation/fibrinolysis processes, etc. Also, different combinations of CSF markers might help to differentiate between etiologic types of dementia. In the future, to translate these findings into clinical practice and use biomarkers to early diagnosis and monitoring vascular cognitive impairment would require the replication of candidate markers in large-scale, multicenter, and prospectively designed studies.

[Rendu-Osler-Weber disease as an infrequent cause of stroke]. / Enfermedad de Rendu-Osler-Weber como causa infrecuente de ictus.

INTRODUCTION: Hereditary haemorrhagic telangiectasia, or Rendu-Osler disease, is a congenital vascular disease that is associated with the presence of arteriovenous fistulas that cause paradoxical embolisms. CASE REPORT: An 83-year-old female with clinical signs and symptoms of convulsive attacks and multiple cerebral infarctions in the acute phase. She also presented a history of multiple haemorrhages and iron deficiency anaemia with no clear aetiological causation. A thorough examination of her medical history revealed a family history of haemorrhages and a sister who had been diagnosed with Rendu-Osler disease, which suggested the possible existence of a pulmonary arteriovenous fistula as the aetiological causation of her cerebrovascular disease. Neurovascular Doppler ultrasonography with bubble contrast test was positive, and the presence of the fistula was confirmed by a computerised axial tomographic angiography scan of the lungs. CONCLUSIONS: Rendu-Osler disease is a rare cause of stroke due to the fact that it is usually associated with arteriovenous fistulas that can cause paradoxical embolisms. Neurovascular Doppler ultrasound scanning is useful for detecting these pulmonary fistulas by means of the bubble contrast test, which is a non-invasive test that can be carried out easily by neurologists themselves.

Enfermedad de Rendu-Osler-Weber como causa infrecuente de ictus / Rendu-osler-weber disease as an infrequent cause of stroke

La telangiectasia hemorrágica hereditaria o enfermedad de Rendu-Osler es una enfermedad vascularcongénita que se asocia con la presencia de fístulas arteriovenosas que son causa de embolias paradójicas. Caso clínico. Mujer de 83 años que ingresa con clínica de crisis epilépticas y múltiples infartos cerebrales en fase aguda. Asocia historiaprevia de múltiples hemorragias y anemia ferropénica sin clara causa etiológica. Tras una exhaustiva anamnesis, se descubre historia familiar de hemorragias y una hermana diagnosticada de enfermedad de Rendu-Osler-Weber, lo que sugiere la posible existencia de una fístula arteriovenosa pulmonar como causa etiológica de su enfermedad cerebrovascular. Se realiza Doppler neurovascular con infusión de test de burbujas con resultado positivo, lo cual confirma la presencia de la fístula mediante angiotomografía axial computarizada pulmonar. Conclusión. La enfermedad de Rendu-Osler es una causa poco frecuente de ictus debido a que suele asociar fístulas arteriovenosas que pueden ser causa de embolias paradójicas. El Doppler neurovascular es útil para la detección de estas fístulas pulmonares mediante el test de infusión de burbujas; se trata de unaprueba no cruenta y de fácil realización por parte de los propios neurólogos

Hereditary haemorrhagic telangiectasia, or Rendu-Osler disease, is a congenital vascular diseasethat is associated with the presence of arteriovenous fistulas that cause paradoxical embolisms. Case report. An 83-year-old female with clinical signs and symptoms of convulsive attacks and multiple cerebral infarctions in the acute phase. She also presented a history of multiple haemorrhages and iron deficiency anaemia with no clear aetiological causation. A thoroughexamination of her medical history revealed a family history of haemorrhages and a sister who had been diagnosed with Rendu-Osler disease, which suggested the possible existence of a pulmonary arteriovenous fistula as the aetiological causation of her cerebrovascular disease. Neurovascular Doppler ultrasonography with bubble contrast test was positive, and the presence of the fistula was confirmed by a computerised axial tomographic angiography scan of the lungs. Conclusions. Rendu-Osler disease is a rare cause of stroke due to the fact that it is usually associated with arteriovenous fistulas that can cause paradoxical embolisms. Neurovascular Doppler ultrasound scanning is useful for detecting these pulmonary fistulas by means of the bubble contrast test, which is a non-invasive test that can be carried out easily by neurologists themselves