University of Khartoum

Cerebrovascular Disorders: Small Vessel Diseases of the Brain

Cerebrovascular Disorders: Small Vessel Diseases of the Brain

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Title: Cerebrovascular Disorders: Small Vessel Diseases of the Brain
Author: Kalaria, Raj N
Abstract: In this lecture, I will focus on the main types of cerebrovascular disease (CBV) that lead to vascular cognitive impairment (VCI), which incorporates all causes of vascular disease. The integrity of the vasculature is essential for the optimal functioning of the brain. In addition to the cardiovascular system, brain vascular control mechanisms are vital for the maintenance of the neurovascular milieu, created by nerve terminals, astrocytic endfeet and the microvasculature. The degree of cerebral grey matter damage, neuronal death and survival will be dictated by the multiplicity, size and laterality of the tissue injury or the extent of vascular disease. Anatomical features of the circulation including the size of vessels and their distribution as well as vascular wall cellular elements e.g. arterioles versus capillaries are important factors in defining the pathology and causes of CBV such as large infarcts, haemorrhages, lacunes, microinfarcts, amyloid and non-amyloid angiopathies, vasculitis, arterial dissection and aneurysms. The origin and degree of vascular occlusion or injury and whether this results in ischaemic or haemorrhagic lesions are further factors which define the extent and severity of damage. Atherothromboembolism attributed to large vessel disease and subcortical lesions (including the white matter) described by intracranial small vessel disease (SVD) are considered to be the main causes of cerebral ischaemia. Sporadic SVDs of the brain account for about 25% of all conditions, which involve transient ischaemic episodes and strokes. SVD is actually a radiological term but entails tissue changes affecting arteries, arterioles, capillaries and small veins. It involves lacunar infarcts and multiple microinfarcts in subcortical structures including the white matter, basal ganglia, thalamus and the brainstem. Among post-stroke survivors who develop dementia, particularly vascular dementia (VaD) more than 50% have strong evidence of SVD. Several inherited forms of SVD have been described in the past decade. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common of these caused by >190 different mutations in the NOTCH3 gene. It is characterised by lacunar infarcts accompanied by diffuse white matter changes and severe arteriosclerosis in the general absence of risk factors for cerebrovascular disease. Recent elucidation of less common hereditary small vessel diseases include CARASIL, RVCL and COL4-related conditions. Our work is supported by the Medical Research Council (UK), Alzheimer’s Research Trust (UK) and Dunhill Medical Trust (UK).
URI: http://khartoumspace.uofk.edu/handle/123456789/9999
Date: 2015-02


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