Neurodegenerative Cerebrovascular Disease Flashcards
What is lacunar stroke? What is the size of this stroke? Where does it primarily occur?
- small vessel disease of the penetrating artery
- <15mm
- subcortical or brainstem
What is lacunar stroke pathology?
- arteriolosclerosis, lipohyalinosis, fibrinoid necrosis
- perivascular inflammatory cells
- microatheroma
- endothelial dysfunction
What are some small vessel diseases other than lacunar stroke?
- white matter Hyperintensities
- dilated perivascular space
- microhemorrhage
- microinfarcts
- cerebral atrophy
- microvascular disease of other organs (renal, cardiac, retinal disease)
What are the clinical manifestations of lacunar stroke and CSVD? What percentage of ischemic strokes does it account for? What percentage of dementia does it account for?
- stroke
- cognitive decline
- gait impairment
- 20% of ischemic strokes
- 45% of dementia
What are some imaging features of CSVD? (also see diagram on slide 30)
- lacunar stroke
- white matter hyperintensities
- microhemorrhage
- dilated perivascular space
What can you visualize for CSVD using high res MRI?
- microinfarcts
- DTI: altered white matter integrity,
altered myelination, free water
What is the proposed mechanism of CSVD?
- ischemia –> occlusion –> thrombosis, vasospasm, impaired autoregulation, hypoperfusion
- endothelial failure –> increased permeability –> Perivascular infiltration, vessel injury, inflammation, impaired autoregulation, luminal narrowing / occlusion
How is hypertension related to CSVD?
ENDOTHELIAL DYSFUNCTION IN BRAIN SMALL VESSELS
- Enhanced permeability / plasma extravasation
- Increased leukocyte adhesion
- Fibrin deposition (lipohyalinosis, fibrinoid necrosis)
- Autoregulation impaired, reduced vasodilatory capacity
- Arteriolar thrombosis
How is inflammation related to CSVD?
- Inflammation affects endothelium and Blood Brain Barrier
- Inflammatory makers are increased in lacunar stroke and associated with WMH progression
salt promotes ______, ___________, ______________.
oxidative stress, inflammation, small vessel dz
___________________ precede(s) hypertension in SHRSP.
small vessel changes
What are treatments of CSVD? Are there any treatments specific to CSVD?
- BP control
- single antiplatelet
- vascular disk factor management
- no specific treatment
slide 18???
What is happening lol
What are the causes of endothelial dysfunction in patieints with CSVD?
- hypertension
- diabetes
- inflammation
- genetics
- impaired endothelial support (Astrocytes, Pericytes, Neurons, Oligodendrocytes, ECM)
TRUE or FALSE: WMH is heritable
TRUE
know genes from slide 20????
TRUE or FALSE: BP control alone can improve endothelial function
FALSE: Blood pressure predicts progression of WMH. However antihypertension treatment has limited effect on slowing WMH
progression
What is cerebral amyloid angiopathy? What risk is it associated with?
- amyloid deposition in cerebral vasculature
- increased risk of cognitive impairment and ICH
What are the MRI features of cerebral amyloid angiopathy?
- cortical superficial siderosis
- lobar intracerebral hematoma
- convexity subarachnoid hemorrhage
- white matter disconnection
- atrophy
- lobar microbleeds
chart on slide 24???
What is the modified boston criteria for definite CAA?
Full postmortem exam demonstrating:
- lobar, cortical or cortical-subcortical hemorrhage
- severe CAA with vasculopathy
- absence of other diagnostic lesion
What isthe modified boston criteria for probably CAA with supporting pathology?
Clinical data and pathological tissue demonstrating:
- lobar, cortical, or cortical-subcortical hemorrhage
- some degree of CAA
- absence of other diagnostic lesion
What is the modified Boston criteria for probable CAA?
Clinical data and MRI or CT demonstrating:
- MULTIPLE hemorrhages restricted to lobar, cortical, or cortical-subcortical hemorrhage and cSS
- age > 55
- absence of other cause of hemorrhage
What is the modified Boston criteria for possible CAA?
Clinical data and MRI or CT demonstrating:
- SINGLE lobar, cortical, or cortical-subcortical ICH, CMB, or cSS
- age > 55
- absence of other cause of hemorrhage
What are the types of sporadic CAA?
type 1 and type 2
What are the familial types (genes) of CAA ? - probably don’t have to know lol
- E693Q (Dutch), E693K (Italian), and L705V (Piedmont)
- E693G (Arctic) and D694N (Iowa)
- E693Q (HCHWA-D)
continue slide 27
