Risk factor profile of cerebral small vessel disease and its subtypes
Reads0
Chats0
TLDR
SVD has a different risk factor profile from the typical atherosclerotic profile found in LVD, with hypertension being important, and the association of ILI with hypercholesterolaemia, diabetes and myocardial infarction may be consistent with a more atheosclerotic aetiology.Abstract:
Background: The mechanisms of cerebral small vessel disease (SVD) are unclear. Both atherosclerosis and a non-atherosclerotic diffuse arteriopathy have been reported pathologically. Two pathological and radiological subtypes have been suggested: localised atherosclerotic disease in larger perforating arteries causing larger lacunar infarcts without leukoaraiosis, and diffuse disease in smaller arterioles causing multiple smaller lacunar infarcts with leukoaraiosis. If atherosclerosis were important in SVD as a whole or in one particular subtype, one would expect the risk factor profile to be similar to that of cerebral large vessel disease (LVD).
Methods: Risk factor profiles were compared in Caucasian stroke patients with SVD (n = 414), LVD (n = 471) and 734 stroke-free Caucasian population controls. Patients with SVD were subdivided according to the presence or absence of confluent leukoaraiosis, into isolated lacunar infarction (ILI) and ischaemic leukoaraiosis (ILA).
Results: Hypertension was commoner in SVD than LVD (odds ratio (OR) 3.43 (2.32 to 5.07); p<0.001) whereas hypercholesterolaemia (OR 0.34 (0.24 to 0.48); p<0.001), smoking (OR 0.63 (0.44 to 0.91); p = 0.012), myocardial infarction (OR 0.35 (0.20 to 0.59); p<0.001) and peripheral vascular disease (OR 0.32 (0.20 to 0.50); p<0.001) were commoner in LVD. Among SVD patients, age (OR 1.11 (1.09 to 1.14); p<0.001) and hypertension (OR 3.32 (1.56 to 7.07); p = 0.002) were associated with ILA and hypercholesterolaemia (OR 0.45 (0.28 to 0.74); p = 0.002), diabetes (OR 0.42 (0.21 to 0.84); p = 0.014) and myocardial infarction (OR 0.18 (0.06 to 0.52); p = 0.001) with ILI.
Conclusion: SVD has a different risk factor profile from the typical atherosclerotic profile found in LVD, with hypertension being important. There are differences in the risk factor profile between the SVD subtypes; the association of ILI with hypercholesterolaemia, diabetes and myocardial infarction may be consistent with a more atherosclerotic aetiology.read more
Citations
More filters
Journal ArticleDOI
Classification of white matter lesions on magnetic resonance imaging in elderly persons.
TL;DR: A new subclassification of white matter lesions is suggested that might have better etiological and functional relevance than the current simple dichotomization and might contribute to reducing the heterogeneity ofwhite matter lesion findings in future research.
Journal ArticleDOI
CNS small vessel disease: A clinical review.
Rocco J. Cannistraro,Mohammed K. Badi,Benjamin H. Eidelman,Dennis W. Dickson,Erik H. Middlebrooks,James F. Meschia +5 more
TL;DR: Early identification of pathologic characteristics with advanced imaging provides an opportunity to forestall progression before emergence of symptoms, and advanced imaging modalities can detect signs of disease even earlier than current standard imaging techniques.
Journal ArticleDOI
Do in vivo experimental models reflect human cerebral small vessel disease? A systematic review.
TL;DR: A systematic review of animal models of SVD determined whether these resemble four key clinicopathologic features: small, discrete infarcts; small vessel arteriopathy; diffuse white matter damage; cognitive impairment; chronic hypertensive models; and the stroke-prone spontaneously hypertensive rat (SHR-SP).
Journal ArticleDOI
Virchow-Robin spaces relate to cerebral small vessel disease severity
TL;DR: Dilated VRs in the basal ganglia relate to the severity of cerebral small vessel disease and might be a manifestation of the same small vessel abnormality that causes silent ischemic lesions, adding a role for VRs as a potential marker for small vessel Disease.
Journal ArticleDOI
Age-related cerebral white matter disease (leukoaraiosis): a review
Basil E Grueter,Ursula G. Schulz +1 more
TL;DR: This review summarises the current literature on cerebral small vessel disease, with an emphasis on its clinical aspects and indicates that some of this information is conflicting.
References
More filters
Journal ArticleDOI
Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation.
K. G. M. M. Alberti,Paul Zimmet +1 more
TL;DR: A WHO Consultation has taken place in parallel with a report by an American Diabetes Association Expert Committee to re‐examine diagnostic criteria and classification of diabetes mellitus and is hoped that the new classification will allow better classification of individuals and lead to fewer therapeutic misjudgements.
Journal ArticleDOI
Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment
Harold P. Adams,Birgitte H. Bendixen,L J Kappelle,José Biller,Betsy B. Love,David Lee Gordon,E. Eugene Marsh +6 more
TL;DR: The TOAST stroke subtype classification system is easy to use and has good interobserver agreement and should allow investigators to report responses to treatment among important subgroups of patients with ischemic stroke.
Journal Article
1999 world health organization-international society of hypertension guidelines for the management of hypertension
Michael H. Alderman,K. Arakawa,L. Beilin,John Chalmers,S. Erdine,M. Fujishima,P. Hamet,L. Hannson,Lewis Landsberg,F. Leenen,L. Lindholm,L. Lisheng,A. F B Mabadeje,S. MacMahon,G. Mancia,I. Martin,A. Mimran,K. H. Rahn,A. Ribeiro,P. Sleight,J. Whitworth,Alberto Zanchetti,Bruce Neal,Anthony Rodgers,C. N. Mhurchu,T. Clark +25 more
Journal ArticleDOI
Classification and natural history of clinically identifiable subtypes of cerebral infarction
TL;DR: There were striking differences in natural history between the groups and the findings have important implications for the planning of stroke treatment trials and suggest that various therapies could be directed specifically at the subgroups.
Journal ArticleDOI
Pathologic correlates of incidental MRI white matter signal hyperintensities
Franz Fazekas,R. Kleinert,Hans Offenbacher,Reinhold Schmidt,G. Kleinert,F. Payer,H. Radner,Helmut Lechner +7 more
TL;DR: The histopathologic changes associated with incidental white matter signal hyperintensities on MRIs from 11 elderly patients are related to a descriptive classification for such abnormalities, and this classification appears to reflect both the different etiologies and severities of incidental MRI signal abnormalities, if it is modified to treat irregular periventricular and confluent deep white matter hyperintENSities together.
Related Papers (5)
Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges.
Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration
Joanna M. Wardlaw,Eric E. Smith,Geert J. Biessels,Charlotte Cordonnier,Franz Fazekas,Richard Frayne,Richard I. Lindley,John T. O'Brien,Frederik Barkhof,Oscar R. Benavente,Sandra E. Black,Carol Brayne,Monique M.B. Breteler,Hugues Chabriat,Charles DeCarli,Frank-Erik de Leeuw,Fergus N. Doubal,Marco Duering,Nick C. Fox,Steven M. Greenberg,Vladimir Hachinski,Ingo Kilimann,Vincent Mok,Robert J. van Oostenbrugge,Leonardo Pantoni,Oliver Speck,Blossom C. M. Stephan,Stefan J. Teipel,Anand Viswanathan,David J. Werring,Christopher Chen,Colin Smith,Mark A. van Buchem,Bo Norrving,Philip B. Gorelick,Martin Dichgans +35 more