Clinical and etiological associations in chronic cerebral ischemia

Abstract

Objective: to study the clinical features of chronic cerebral ischemia (CCI) in relation to the leading etiological factor. Patients and methods. Examinations were made in 515 non-stroke CCI patients: 306 men and 209 women aged 58 to 75 years with hypertension and no obvious atherosclerosis of head and neck vessels (n=197); with obvious atherosclerosis of head and neck vessels and no hypertension (n=157); with obvious atherosclerosis of head and neck vessels and hypertension (n=161). In all cases, the investigators performed standard neurological examination and evaluated cognitive, affective symptoms with a set of neuropsychological scales and equilibrium and gait abnormalities with the Tinetti scale. Results and discussion. The development of extrapyramidal syndrome was more related to hypertension or its concurrence with the atherosclerotic process. The patients with atherosclerosis and no hypertension showed a more distinct differentiation of clinical syndromes, which was associated with stenosis in the specific vascular bed; this was probably due to decreased local perfusion. A relationship was established between hypertension and the development of severe cognitive impairments (CIs) that had predominantly a dysregulation neuropsychological profile. In the patients with atherosclerosis and no hypertension, emotional disorders were more common than CI and the latter resembled Alzheimer’s disease. A differentiated prophylactic and therapeutic strategy accounting for the leading etiological factor will be able to prevent or significantly reduce functional limitations in patients with CCI.