Neurodegenerative Cerebrovascular Disease (Jickling) Flashcards
What is the underlying disease that causes lacunar stroke?
lipohyalinosis
What is the greatest risk factor for CSVD?
hypertension
What is the main pathology of CAA?
plaque in blood vessel wall
What are some factors that lead to vascular dementia?
- focal infarcts
- microvascular disease
- white matter disease
- amyloid angiopathy
What is lacunar stroke?
small vessel disease of the penetrating artery
what is the size of a lacunar stroke?
<15mm
Where does lacunar stroke occur?
subcortical or brainstem
What is the pathology of lacunar stroke?
- arteriolosclerosis, lipohyalinosis, fibrinoid necrosis
- perivascular inflammatory cells
- microatheroma
- endothelial dysfunction
What are the clinical manifestations of lacunar stroke and CSVD?
- stroke
- cognitive decline
- gait impairment
What are some imaging features of CSVD?
- lacunar stroke
- white matter hyperintensities
- microhemorrhage
- dilated perivascular space
What are some DTI features of CSVD?
- altered white matter integrity
- altered myelination
- free water
What is the proposed mechanism of CSVD?
- 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
In CSVD, inflammation affects _____________ and __________.
endothelium; BBB
__________ __________ ___________ are part of the pathology of CSVD.
inflammatory cell infiltrates
_______________ markers are increased with lacunar stroke and associated with ___________.
inflammatory; WMH progression
____________ promotes oxidative stress, inflammation, small vessel disease
salt
_______________ precede hypertension in SHRSP
small vessel changes
What is the main form of treatment of CSVD? what are some other treatment options?
- blood pressure control = main
- single antiplatelet –> aspirin (controversial)
- vascular risk factor management (e.g. cholesterol and diabetes)
What are some causes off endothelial dysfunction in patients with CSVD?
- hypertension
- diabetes
- inflammation
- genetics
- impaired endothelial support (astrocytes, pericytes, neurons, oligodendrocytes, ECM)
TRUE or FALSE: WMH is not heritable
FALSE: it is heritable
What predicts the progression of WMH?
blood pressire
TRUE or FALSE: blood pressure control alone may be sufficient to improve endothelial function
FALSE: it may be INSUFFICIENT - anti-hypertension treatment has limited effect on slowing WMH progression
What is cerebral amyloid angiopathy?
amyloid deposition in cerevral vsculature
CAA is associated with an increased risk of _______ and __________
cognitive impairment, ICH
What is the best way to identify CAA?
MRI
What is the only real way to diagnose CAA?
autopsy
How is CAA plaque treatment different from AD?
may be able to remove amyloid from blood vessels in CAA
What form of APP is seen in CAA?
APP770
