Abstract
ObjectiveAlthough the clinical manifestation and risk factors of cerebral microangiopathy (CM) remain unclear, the number of diagnoses is increasing. Hence, patterns of association among lesion topography and severity, clinical symptoms and demographic and disease risk factors were investigated retrospectively in a cohort of CM patients.MethodsPatients treated at the Department of Neurology, University of Bonn for CM (n = 223; 98m, 125f; aged 77.32±9.09) from 2005 to 2010 were retrospectively enrolled. Clinical symptoms, blood chemistry, potential risk factors, demographic data and ratings of vascular pathology in the brain based on the Wahlund scale were analyzed using Pearson's chi square test and one-way ANOVA.ResultsProgressive cognitive decline (38.1%), gait apraxia (27.8%), stroke-related symptoms and seizures (24.2%), TIA-symptoms (22%) and vertigo (17%) were frequent symptoms within the study population. Frontal lobe WMLs/lacunar infarcts led to more frequent presentation of progressive cognitive decline, seizures, gait apraxia, stroke-related symptoms, TIA, vertigo and incontinence. Parietooccipital WMLs/lacunar infarcts were related to higher frequencies of TIA, seizures and incontinence. Basal ganglia WMLs/lacunar infarcts were seen in patients with more complaints of gait apraxia, vertigo and incontinence. Age (p = .012), arterial hypertension (p<.000), obesity (p<.000) and cerebral macroangiopathy (p = .018) were positively related to cerebral lesion load. For increased glucose level, homocysteine, CRP and D-Dimers there was no association.ConclusionThis underlines the association of CM with neurological symptoms upon admission in a topographical manner. Seizures and vertigo are symptoms of CM which may have been missed in previous studies. In addition to confirming known risk factors such as aging and arterial hypertension, obesity appears to increase the risk as well. Since the incidence of CM is increasing, future studies should focus on the importance of prevention of vascular risk factors on its pathogenesis.
Highlights
Cerebral microangiopathy (CM), cerebral small vessel disease, is diagnosed with increasing frequency
Studies of associations between blood chemistry markers (d-dimers, homocysteine and C-reactive protein (CRP)) and CM have yielded inconsistent results [18,19,20,21,22,23]. For these reasons we retrospectively examined clinical symptoms, blood chemistry, potential risk factors and demographic data in a large cohort of patients looking for patterns related to vascular pathology in the brain
Symptoms associated with CM at admittance Of the symptoms associated with CM, progressive memory impairment was the most frequent (38.1%), followed by gait apraxia (27.8%), stroke-related-symptoms and seizures (24.2%), transient ischemic attack (TIA)-symptoms (22%), vertigo (17%) and incontinence (7.2%) (Fig. 1A)
Summary
Cerebral microangiopathy (CM), cerebral small vessel disease, is diagnosed with increasing frequency. Improved neuroimaging techniques, aging, as well as dietary and life-style changes leading to a higher incidence of vascular risk factors may play an important role. CM refers to pathological changes in small brain vessels, including small arteries, arterioles, capillaries and small veins [1]. It is associated with white matter lesions (WMLs), lacunar infarcts, and, more recently, microbleeds [2,3,4]. CM manifests itself in manifold clinical symptoms including gait disorders, [5] urinary disturbances, [6] depression [7] and cognitive decline [8,9,10]. Study of the clinical manifestations of CM is warranted
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