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cerebrovascular disease/disorder

Etiology: - atherosclerosis - advanced age - hypertension - excessive dietary salt may contribute to progression of cerebral small vessel disease in older adults [9] - effects of salt may be mediated in part by hypertension - arterial embolism - atrial fibrillation - atrial septal defect - cerebral vasculitis - cerebral amyloid angiopathy Epidemiology: - as common as cardiovascular disease [1] Pathology: - microvascular disease - lacunar infarcts - leukoaraiosis Clinical manifestations: - may have difficulty rising from chair - difficulty starting to walk - slow gait - diminished foot clearance - tendency to fall backward [2] Special laboratory: - poor performance on the trailmaking B test may be a manifestation of unrecognized cerebrovascular disease [3,4] Radiology: - MRI neuroimaging to score cerebral small-vessel disease may help predict dementia [7] Complications: - vascular Parkinsonism [8] - vascular dementia [7] Management: - medical therapy better than intracranial stenting - benefit of intracranial angioplasty without stenting has not been demonstrated [6] - treat hypertension - reducing dietary salt my reduce risk [9] - treat dyslipidemia

Interactions

disease interactions

Specific

atherosclerotic intracranial arterial stenosis basilar artery disease carotid artery disease cerebral amyloid angiopathy (CAA) cerebrovascular hemorrhage Moyamoya disease stroke; cerebrovascular accident (CVA) vascular dementia

General

disease/disorder primarily affecting brain vascular disease (vasculopathy)

References

  1. Rothwell PM et al, Population-based study of event-rate, incidence, case-fatality, and mortality for all acute vascular events in all arterial territories. (Oxford Vascular Study) Lancet 2005; 366:1773 PMID: 16298214
  2. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
  3. Wiberg R et al Cognitive function and risk of stroke in elderly men Neurology, 2010 74(5):379-385 http://www.neurology.org/content/74/5/379
  4. Wiberg B et al The relationship between executive dysfunction and post-stroke mortality: A population-based cohort study. BMJ Open 2012 May 9; 2:e000458 PMID: 22573701
  5. Turan TN, Cotsonis G, Lynn MJ et al Relationship between blood pressure and stroke recurrence in patients with intracranial arterial stenosis. Circulation. 2007 Jun 12;115(23):2969-75. PMID: 17515467
  6. Derdeyn CP et al. Aggressive medical treatment with or without stenting in high-risk patients with intracranial artery stenosis (SAMMPRIS): The final results of a randomised trial. Lancet 2013 Oct 26 PMID: 24168957 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62038-3/fulltext
  7. Amin Al Olama A et al. Simple MRI score aids prediction of dementia in cerebral small vessel disease. Neurology 2020 Mar 24; 94:e1294. PMID: 32123050 https://n.neurology.org/content/94/12/e1294
  8. Jacob MA et al. Cerebral small vessel disease progression increases risk of incident parkinsonism. Ann Neurol 2023 Feb 10; [e-pub]. PMID: 36762437 https://onlinelibrary.wiley.com/doi/10.1002/ana.26615
  9. Liu D, Zhang Q, Xing S et al Excessive salt intake accelerates the progression of cerebral small vessel disease in older adults. BMC Geriatrics. 2023. May 2. PMID: 37131130 PMCID: PMC10155382 Free PMC article https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-023-03877-3