Neurodegenerative Cerebrovascular Disease (Jickling)

Question 1

What is the underlying disease that causes lacunar stroke?

Answer 1

lipohyalinosis

Question 2

What is the greatest risk factor for CSVD?

Answer 2

hypertension

Question 3

What is the main pathology of CAA?

Answer 3

plaque in blood vessel wall

Question 4

What are some factors that lead to vascular dementia?

Answer 4

• focal infarcts
• microvascular disease
• white matter disease
• amyloid angiopathy

Question 5

What is lacunar stroke?

Answer 5

small vessel disease of the penetrating artery

Question 6

what is the size of a lacunar stroke?

Answer 6

<15mm

Question 7

Where does lacunar stroke occur?

Answer 7

subcortical or brainstem

Question 8

What is the pathology of lacunar stroke?

Answer 8

• arteriolosclerosis, lipohyalinosis, fibrinoid necrosis
• perivascular inflammatory cells
• microatheroma
• endothelial dysfunction

Question 9

What are the clinical manifestations of lacunar stroke and CSVD?

Answer 9

• stroke
• cognitive decline
• gait impairment

Question 10

What are some imaging features of CSVD?

Answer 10

• lacunar stroke
• white matter hyperintensities
• microhemorrhage
• dilated perivascular space

Question 11

What are some DTI features of CSVD?

Answer 11

• altered white matter integrity
• altered myelination
• free water

Question 12

What is the proposed mechanism of CSVD?

Answer 12

• ISCHEMIA from occlusion, thrombosis, vasospasm, impaired autoregulation, hypoperfusion
• ENDOTHELIAL FAILURE (i.e. increased permeability to toxic factors) leading to perivascular infiltration, vessel injury, inflammation, impaired autoregulation, luminal narrowing/occlusion

Question 13

In CSVD, inflammation affects _____________ and __________.

Answer 13

endothelium; BBB

Question 14

__________ __________ ___________ are part of the pathology of CSVD.

Answer 14

inflammatory cell infiltrates

Question 15

_______________ markers are increased with lacunar stroke and associated with ___________.

Answer 15

inflammatory; WMH progression

Question 16

____________ promotes oxidative stress, inflammation, small vessel disease

Answer 16

salt

Question 17

_______________ precede hypertension in SHRSP

Answer 17

small vessel changes

Question 18

What is the main form of treatment of CSVD? what are some other treatment options?

Answer 18

• blood pressure control = main
• single antiplatelet –> aspirin (controversial)
• vascular risk factor management (e.g. cholesterol and diabetes)

Question 19

What are some causes off endothelial dysfunction in patients with CSVD?

Answer 19

• hypertension
• diabetes
• inflammation
• genetics
• impaired endothelial support (astrocytes, pericytes, neurons, oligodendrocytes, ECM)

Question 20

TRUE or FALSE: WMH is not heritable

Answer 20

FALSE: it is heritable

Question 21

What predicts the progression of WMH?

Answer 21

blood pressire

Question 22

TRUE or FALSE: blood pressure control alone may be sufficient to improve endothelial function

Answer 22

FALSE: it may be INSUFFICIENT - anti-hypertension treatment has limited effect on slowing WMH progression

Question 23

What is cerebral amyloid angiopathy?

Answer 23

amyloid deposition in cerevral vsculature

Question 24

CAA is associated with an increased risk of _______ and __________

Answer 24

cognitive impairment, ICH

Question 25

What is the best way to identify CAA?

Answer 25

MRI

Question 26

What is the only real way to diagnose CAA?

Answer 26

autopsy

Question 27

How is CAA plaque treatment different from AD?

Answer 27

may be able to remove amyloid from blood vessels in CAA

Question 28

What form of APP is seen in CAA?

Answer 28

APP770