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Cerebral small vessel disease stroke , dementia, affective disturbance and abnormal gait.
Histological manifestations included recent subcortical infarcts and microinfarcts, lacunar foci, white matter hyperintensity (WMH), microbleeds and hemorrhagic foci, perivascular space enlargement, and brain atrophy
.
Cerebral small vessel disease is a catastrophic damage involving the small blood vessels of the whole brain.
Cerebral small vessel disease stroke , dementia, affective disturbance and abnormal gait.
1.
Clinical Lacunar Stroke1.
Clinical Lacunar Stroke 1.
Lacunar ischemic stroke refers to lesions involving the white matter, basal ganglia, pons, and brainstem, with a diameter of less than 1.
5 cm (some thought to be less than 2 cm), and the corresponding clinical lacunar syndrome
.
5 cm (some thought to be less than 2 cm), and the corresponding clinical lacunar syndrome
.
Lacunar ischemic stroke refers to lesions involving the white matter, basal ganglia, pons, and brainstem, with a diameter of less than 1.
2.
Risk factors and etiology of lacunar infarction
Risk factors and etiology of lacunar infarction 2.
Risk factors and etiology of lacunar infarction
The four main causes of lacunar ischemic stroke are paternal atherosclerosis (usually the middle cerebral artery), perforating atherosclerosis, embolism from the heart, aortic arch, or carotid arteries, and cerebral small vessel disease ( including lipid hyaline and fibrinoid necrosis) (Figure 1)
.
.
3.
Clinical "quiet focus" cerebral small vessel disease
Clinical "quiet focus" cerebral small vessel disease
①White matter hyperintensity: one of the typical imaging manifestations of cerebral small vessel disease
.
.
② Lacunar foci (Fig.
2): In fact, lacunar foci are not always "ischemic" and can also be seen in residual lesions of microbleeds
.
These lesions often lack the clinical manifestations of the corresponding lacunar syndrome
② Lacunar foci (Fig.
③ Enlargement of perivascular space: Whether it is a "damaged" lesion is debatable, but it suggests blood-brain barrier damage
.
.
④ Cerebral microbleeds: Usually asymptomatic, it is unclear whether it increases the risk of cerebral hemorrhage
.
.
⑤ Risk factors and etiology of clinical "static" cerebral small vessel disease: hypertension , hyperlipidemia, smoking and diabetes , especially hypertension
.
.
high blood pressure diabetes
4.
Cerebral small vessel disease is a “whole brain disease”
4.
Cerebral small vessel disease is a “whole brain disease”
Cerebral small vessel disease is a "whole brain disease" 4.
Cerebral small vessel disease is a "whole brain disease"
Small vessel pathological changes and blood-brain barrier damage are common in patients with cerebral small vessel disease, suggesting that cerebral small vessel disease is a disease involving the whole brain rather than a focal disease
.
At present, it is believed that there are two reasons that some cerebral small vessel lesions have clinical symptoms, while some are asymptomatic: one is different involved sites, and the other is different levels of involved blood vessels, both of which determine whether there are clinical symptoms
.
Small vessel pathological changes and blood-brain barrier damage are common in patients with cerebral small vessel disease, suggesting that cerebral small vessel disease is a disease involving the whole brain rather than a focal disease
.
At present, it is believed that there are two reasons that some cerebral small vessel lesions have clinical symptoms, while some are asymptomatic: one is different involved sites, and the other is different levels of involved blood vessels, both of which determine whether there are clinical symptoms
.
First, the involved sites are different, and the second is the level of involved blood vessels, both of which determine whether there are clinical symptoms
.
5.
Cerebral small vessel disease is a "dynamic disease"
5.
Cerebral small vessel disease is a "dynamic disease"
Cerebral small vessel disease is a "dynamic disease" 5.
Cerebral small vessel disease is a "dynamic disease"
Serial imaging studies of cerebral small vessel disease have found that the lesions of cerebral small vessel disease are constantly changing
.
Lacunarization is not the only outcome of acute lacunar ischemic stroke, and its lesions can either disappear or manifest as white matter hyperintensity (Figure 3)
.
The dynamic changes of cerebral small vessel disease lesions may reflect different pathophysiological changes, but have similar manifestations at specific times on imaging
.
.
Lacunarization is not the only outcome of acute lacunar ischemic stroke, and its lesions can either disappear or manifest as white matter hyperintensity (Figure 3)
.
The dynamic changes of cerebral small vessel disease lesions may reflect different pathophysiological changes, but have similar manifestations at specific times on imaging
.
6.
Treatment of cerebral small vessel disease
6.
Treatment of cerebral small vessel disease
Treatment of cerebral small vessel disease 6.
Treatment of cerebral small vessel disease
Management of traditional risk factors remains the mainstay of treatment and prevention of cerebral small vessel disease, despite the fact that most of these treatments have not shown desirable effects on long-term outcomes
.
Antihypertensive therapy can produce conflicting results: it reduces WMH progression in some observational studies, but has shown little or no effect in some randomized controlled trials
.
Although hypertension has been reported to be highly associated with cerebral small vessel disease, other factors may also be involved or be influenced by genetic factors
.
.
Antihypertensive therapy can produce conflicting results: it reduces WMH progression in some observational studies, but has shown little or no effect in some randomized controlled trials
.
Although hypertension has been reported to be highly associated with cerebral small vessel disease, other factors may also be involved or be influenced by genetic factors
.
Manage Prevention
Likewise, most lipid-lowering treatments, such as pravastatin, are neutral in preventing WMH progression
.
A post hoc analysis from Hong Kong with a 2-year follow-up showed that statins may delay WMH progression in patients with severe WMH at baseline, and statins may have other therapeutic effects, including anti-inflammatory and endothelialization
.
Other studies have shown that vitamin B supplementation may reduce WMH progression at baseline in patients with severe cerebral small vessel disease
.
However, there are limited studies on the treatment of lacunar stroke specifically
.
Future prevention and treatment of cerebral small vessel disease should consider targeting the blood-brain barrier, cerebral vascular endothelialization, and microvascular function
.
.
A post hoc analysis from Hong Kong with a 2-year follow-up showed that statins may delay WMH progression in patients with severe WMH at baseline, and statins may have other therapeutic effects, including anti-inflammatory and endothelialization
.
Other studies have shown that vitamin B supplementation may reduce WMH progression at baseline in patients with severe cerebral small vessel disease
.
However, there are limited studies on the treatment of lacunar stroke specifically
.
Future prevention and treatment of cerebral small vessel disease should consider targeting the blood-brain barrier, cerebral vascular endothelialization, and microvascular function
.
Future prevention and treatment of cerebral small vessel disease should consider targeting the blood-brain barrier, cerebral vascular endothelialization, and microvascular function
.
7.
Summary
7.
Summary
Summary 7.
Summary
Cerebral small vessel disease is like a "storm" disaster, which affects the whole brain and even the small blood vessels of the whole body; in addition to the superficial damage caused by the "storm" itself, the subsequent damage is still in progress
.
The pathogenesis and treatment of cerebral small vessel disease still need to be further studied
.
.
The pathogenesis and treatment of cerebral small vessel disease still need to be further studied
.
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