IVIM MRI: A Window to the Pathophysiology Underlying Cerebral Small Vessel Disease
Denis Le Bihan, Mami Iima, Christian Federau, Eric E. Sigmund in Intravoxel Incoherent Motion (IVIM) MRI, 2018
Current therapies of lacunar stroke, one of the most common clinical manifestations of cSVD [33], include antiplatelet therapy, blood pressure reduction, and statin therapy [34]. Quantitative IVIM imaging measures were associated with WMHs and may act as potential surrogate markers for structural damage in cSVD [17, 18, 20]. Tissue injury, including lacunae and WMHs, is linked to cognitive decline and physical and psychiatric disabilities [3]. Since the imaging measures may be potential surrogate markers of structural damages in cSVD, these measures can be employed as a neurobiological readout of treatment for patients with cSVD in the short term. For example, vascular risk factors (e.g., smoking, blood pressure, and diabetes) are known to be correlated with WMH severity and the occurrence of lacunae [35]. It can be investigated whether an intervention to improve the vascular condition could lead to less tissue injury in the future. However, prior to conducting this intervention study, which will likely require a long follow-up time, the effect of this intervention on the imaging measures can be studied in the shorter term to gain an early insight into biological responses. For this purpose, longitudinal studies are required to explore the role of imaging measures as surrogate markers of cSVD in more detail. These studies could evaluate whether functional impairment (e.g., abnormal microvasculature and/or parenchyma as shown through IVIM) indeed precedes morphological abnormalities.
Therapeutic Options to Enhance Poststroke Recovery in Aged Humans
Shamim I. Ahmad in Aging: Exploring a Complex Phenomenon, 2017
Spontaneous recovery is common if the infarct is located in the striatum, a subcortical structure that exhibits activity-dependent plasticity and is important for controlling movement and motor learning. The enhanced recovery was associated with structural and synaptic plasticity in the contralesional striatum [46] (Figure 19.1). This may explain why patients with subcortical lacunar stroke are more likely to have early functional recovery after stroke [47,48]. Other studies suggest that the beneficial effect could be due to in situ secretion of neuroprotective factors by the transplanted cells. For example, human-derived inducible pluripotent cells (iPSCs) implanted into the striatum of young animals at 1 week after MCAO protected substantia nigra from atrophy, probably through a trophic effect [49].
Cerebrovascular Disease
John W. Scadding, Nicholas A. Losseff in Clinical Neurology, 2011
Lacunar stroke may be preceded by TIAs in 20 per cent of cases, as in other causes of stroke. The two pathological appearances underlying small vessel occlusion are lipohyalinosis and microatheroma, but the distinction between these two pathologies cannot be made clinically. Although lacunar infarction can be associated with carotid stenosis, it does not commonly happen as a result of cardioembolism. Most patients with lacunar stroke have hypertension, diabetes and/or hypercholesterolaemia. Scans with CT and MRI and autopsy studies show that occlusion of small penetrating vessels with lacunar infarction is commonly asymptomatic.
The D allele of the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism is associated with worse functional outcome of ischaemic stroke
Published in International Journal of Neuroscience, 2018
Rusdy Ghazali Malueka, Ery Kus Dwianingsih, Sri Sutarni, Rheza Gandi Bawono, Halwan Fuad Bayuangga, Abdul Gofir, Ismail Setyopranoto
In total, 61 patients were included in this study. Table 1 shows the demographic and clinical characteristics of the patients. The average age of the patients was 63.85 ± 13.1 years old. There were 36 (59%) men and 25 (41%) women. The most common comorbidity found was the history of hypertension, which was found in 45 (73.8%) patients, followed by diabetes in 23 (37.7%) patients and dyslipidaemia in 12 (19.7%) patients. As much as 16 (26.2%) patients were current smokers. Average cholesterol level at admission was 202.19 ± 60.4 mg/dL, triglyceride level was 105.5 mg/dL and LDL level was 133.94 ± 54.5 mg/dL. A small number of patients experienced complications during treatment, which were pneumonia (8.2%), UTI (11.5%) and gastrointestinal bleeding (3.3%). There were 45 (73.8%) patients who had ≤24 h onset when they were brought to the hospital. The average score of NIHSS at admission was 5. Lacunar stroke type was found in 20 (32.8%) cases. Most patients (65.6%) have ASPECTS score of 8–10. The study found 38 patients (62.3%) with II polymorphism, 22 patients (36.07%) with ID polymorphism and 1 patient (1.63%) with DD polymorphism in the ACE gene. The frequency of D allele was 37.7%.
Association of hemoglobin glycation index with outcomes of acute ischemic stroke in type 2 diabetic patients
Published in Neurological Research, 2018
Yuesong Pan, Jing Jing, Yongjun Wang, Liping Liu, Yilong Wang, Yan He
Several limitations need to be acknowledged when interpreting the results. First, 311 (24%) patients were excluded for missing data or loss to follow-up. However, baseline characteristics of the included and excluded patients were well-balanced. Second, the etiological subtypes of recurrent ischemic strokes were not collected and we failed to investigate the association between the HGI and the subtype of recurrent stroke in this study. Previous studies showed that the subgroup of diabetic patients with lacunar infarction showed better functional prognosis than diabetic non-lacunar stroke patients [27], and hypertension and diabetes were significant factors related to recurrent lacunar infarction [28]. Finally, this study enrolled only Chinese patients, and hence the external generalizability of the findings of these results needs further validation in Western populations. Racial disparity in HbA1c and HGI exists in individuals with diabetes [29].
Clinical implications of extracellular vesicles in neurodegenerative diseases
Published in Expert Review of Molecular Diagnostics, 2019
Lacunar infarcts are a subtype of cerebral small vessel disease that accounts for 25% of the ischemic strokes [100]. The clinical manifestation of lacunar infarcts is varied, ranging from decreased sensation to loss of coordination, sight, speech, and balance. In many cases, the disease manifests as a silent stroke, which patients are not aware of [101]. However, episodes of mild lacunar stroke can gradually destroy brain tissue to eventually result in a state of cognitive impairment and the development of dementia. It is now well accepted that there is a strong link between lacunar infarcts and vascular dementia and AD, especially in elderly patients with AD [102–105]. Therefore, identifying the patients at risk of lacunar infarcts may provide an alternative approach for AD or other neurodegenerative disorder prognosis and diagnosis tools.
Related Knowledge Centers
- Cadaver
- Syndrome
- Vascular Occlusion
- Stroke
- Artery
- Radiology
- Intracranial Hemorrhage
- Silent Stroke
- Magnetic Resonance Imaging
- CT Scan