Cerebral Vascular Disorders Research Articles

Myelin endocytosis by brain endothelial cells causes endothelial iron overload and oligodendroglial iron hunger in hypoperfusion-induced white matter injury.

Hypoperfusion induces significant white matter injury in cerebral vascular disorders, including arteriosclerotic cerebral small vessel disease (aCSVD), which is prevalent among the elderly. Iron transport by blood vessel endothelial cells (BVECs) from the periphery supports oligodendrocyte maturation and white matter repair. This study aims to elucidate the association between iron homeostasis changes and white matter injury severity, and explore the crosstalk between BVECs and oligodendroglial lineage cells. In vivo: C57BL/6 mice were subjected to unilateral common carotid artery occlusion (UCCAO). Invitro: BVECs with myelin pretreatment were co-cultured with oligodendrocyte progenitor cells (OPCs) or organotypic cerebellar slices subjected to oxygen and glucose deprivation. Circulatory iron tends to be stored in aCSVD patients with white matter injury. Myelin debris endocytosis by BVECs impairs iron transport, trapping iron in the blood and away from the brain, worsening oligodendrocyte iron deficiency in hypoperfusion-induced white matter injury. Iron accumulation in BVECs triggers ferroptosis, suppressing iron transport and hindering white matter regeneration. Intranasal holo-transferrin (hTF) administration bypassing the BBB alleviates oligodendrocyte iron deficiency and promotes myelin regeneration in hypoperfusion-induced white matter injury. The iron imbalance between BVECs and oligodendroglial lineage cells is a potential therapeutic target in hypoperfusion-induced white matter injury.

Imaging Review of Pediatric Monogenic CNS Vasculopathy with Genetic Correlation.

Monogenic cerebral vasculopathy is a rare but progressively recognizable cause of pediatric cerebral vasculopathy manifesting as early as fetal life. These monogenic cerebral vasculopathies can be silent or manifest variably as fetal or neonatal distress, neurologic deficit, developmental delay, cerebral palsy, seizures, or stroke. The radiologic findings can be nonspecific, but the presence of disease-specific cerebral and extracerebral imaging features can point to a diagnosis and guide genetic testing, allowing targeted treatment. The authors review the existing literature describing the frequently encountered and rare monogenic cerebral vascular disorders affecting young patients and describe the relevant pathogenesis, with an attempt to categorize them based on the defective step in vascular homeostasis and/or signaling pathways and characteristic cerebrovascular imaging findings. The authors also highlight the role of imaging and a dedicated imaging protocol in identification of distinct cerebral and extracerebral findings crucial in the diagnostic algorithm and selection of genetic testing. Early and precise recognition of these entities allows timely intervention, preventing or delaying complications and thereby improving quality of life. It is also imperative to identify the specific pathogenic variant and pattern of inheritance for satisfactory genetic counseling and care of at-risk family members. Last, the authors present an image-based approach to these young-onset monogenic cerebral vasculopathies that is guided by the size and predominant radiologic characteristics of the affected vessel with reasonable overlap. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

Prognosis of the probability of development and progression of the disease under the influence of factors causing cerebral vascular disorders in vascular parkinsonism

Cerebrovascular disease, according to many studies, causes 1 to 15% of cases of Parkinsonism. “...200 out of every 100,000 people in the world have the disease...”. Parkinson’s disease is a chronically stable progressive, unavoidable disease, second only in prevalence among the elderly and among neurodegenerative diseases worldwide. The number of elderly people worldwide has increased by 48% since 2000 and is expected to continue to increase by 56% between 2015 and 2030. According to the International Parkinson’s Foundation, the number of Parkinson’s disease cases worldwide will exceed 10 million by 2020. In particular, prediction of severe complications based on the analysis of neurological, neurophysiological, neuroimaging features of the clinical course of vascular Parkinsonism, prevention of cognitive and motor disorders, assessment of the patient’s disability index through key quality of life indicators, diagnostic and treatment algorithms, and determination of differential approach measures are of particular importance. A number of scientific studies are being conducted worldwide to clarify the features of optimization of multivariate analysis of cerebral vascular impairment in parkinsonism.

Clinical and Demographic Characteristics of Patients with Neuro-ophthalmological Disorders Starting Later in Life

Objectives: To determine the demographic, etiological and clinical features as well as treatment modalities of patients with neuro-ophthalmological disorders starting at a later age. Materials and Methods: We retrospectively reviewed the clinical data related to the neuro-ophthalmology patients who presented at the age of ≥ 65 years at two tertiary eye care referral centers from 2004 to 2022. Results: Of the 2,127 patients who applied to the Neuro-Ophthalmology Department during this period, 162 (7.6%) were ≥ 65 years old at the time of diagnosis and their data were analyzed. The mean age at the onset of disease was 73.2 ± 6.7 (65–95) years, and mean follow-up time was 1.1±0.4 (1-3) years. Non-arteritic anterior ischemic optic neuropathy (NAAION) (n=85, 52.5%), isolated cranial nerve palsies (n=28, 17.3%), and cerebral vascular disorders (CVD) (n=14, 8.6%) were the most frequent diagnosis. The most common symptoms were as follows: sudden visual loss in 79 (48.8%), diplopia in 31 (19.1%), and blurred vision in 21 (13%) cases. The most common accompanying systemic disease was hypertension (HT) and diabetes mellitus (DM) in 31 (27.4%), followed by HT in 29 (25.7%) cases. There was no accompanying systemic disease in 49 (30.2%) patients. The diagnosis of NAAION and AAION resulted in poor visual outcomes, while CVD presented with homonymous hemianopsia. Conclusion: NAAION and CVD were the most common age-related neuro-ophthalmological disorders that cause visual acuity loss and a visual field defect at an advanced age. Identifying these disorders and managing the visual problems are essential to preserve the protection of the patient's quality of life.

SARS-CoV-2 spike S1 subunit protein-mediated increase of beta-secretase 1 (BACE1) impairs human brain vessel cells

Increasing evidence suggests incomplete recovery of COVID-19 patients, who continue to suffer from cardiovascular diseases, including cerebral vascular disorders (CVD) and neurological symptoms. Recent findings indicate that some of the damaging effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, especially in the brain, may be induced by the spike protein, leading to the disruption of the initial blood-brain barrier (BBB). SARS-CoV-2-infected cells and animals exhibit age-dependent pathogenesis. In this study, we identified endothelial BACE1 as a critical mediator of BBB disruption and cellular senescence induced by the SARS-CoV-2 spike S1 subunit protein. Increased BACE1 in human brain microvascular endothelial cells (HBMVEC) decreases the levels of tight junction proteins, including ZO-1, occludin, and claudins. Moreover, BACE1 overexpression leads to the accumulation of p16 and p21, typical hallmarks of cellular senescence. Our findings show that the SARS-CoV-2 spike S1 subunit protein upregulated BACE1 expression in HBMVECs, causing endothelial leakage. In addition, the SARS-CoV-2 spike S1 subunit protein induced p16 and p21 expression, indicating BACE1-mediated cellular senescence, confirmed by β-Gal staining in HBMVECs. In conclusion, this study demonstrated that BACE1-mediated endothelial cell damage and senescence may be linked to CVD after COVID-19 infection.

Differential expression of non-coding RNAs and association with cerebral ischemic vascular disorders; diagnostic and therapeutic opportunities.

Over the last few decades, research associated with the coding genome, primarily DNA and transcriptome (mRNA, rRNA, and tRNA), has changed our understanding in several aspects, including physiology, diagnostics, and therapeutics. A large proportion of the human genome that encodes proteins is essential for physiology. However, the human genome represents a significantly large proportion of non-translational, i.e., non-coding (nc) RNAs like microRNAs, siRNAs, piRNAs, lncRNAs, and circRNAs. These ncRNAs do not translate into functional proteins but are associated with several events, such as the regulation of gene expression via several mechanisms. Our understanding of ncRNAs has advanced in the last decade, such as microRNAs and siRNAs, but still, several other ncRNAs remain unexplored. The study comprehended the association of ncRNAs in cerebral ischemia. In this study searches utilizing multiple databases, PubMed, EMBASE, and Google Scholar were made. The literature survey was done on ncRNA including short and lncRNA associated with the onset, and progression of cerebral ischemia. The literature search was also made for the studies associated with the diagnostic and therapeutic role of ncRNAs for cerebral ischemia. Reports suggested that both short and long ncRNAs are critical players of gene expression and are hence associated with the pathophysiology of cerebral ischemia. The reports demonstrate ncRNAs precisely lncRNAs and microRNAs are not only associated with cerebral ischemia progression but also potential diagnostic and therapeutic candidates. This review is certainly helpful to understand the interplay of ncRNAs in understanding gene expression profile and pathophysiology of cerebral ischemia. These ncRNAs molecules show potential for diagnostic and therapeutic development.

Cognitive Impairment in Primary and Secondary Headache Disorders.

Purpose of ReviewTo critically evaluate the recent literature on cognitive impairment and headache.Recent FindingsNeurocognitive symptoms are prevalent, debilitating, and occur often with both primary and secondary headache disorders.SummaryThis is a “narrative review of the current literature in PubMed on cognitive function and headache.” Migraine is associated with cognitive impairment years before a migraine diagnosis. In young and middle-aged adults, migraine is associated with deficits in attention, executive function, processing speed, and memory. It is unlikely that migraine is associated with dementia. Although methodologically difficult to assess, there does not seem to be an association between tension-type headache and cognitive dysfunction. In early to midlife, cluster headache seems to be associated with executive dysfunction. Several secondary headache syndromes relevant to clinicians managing headache disorders are associated with poorer cognitive performance or distinctive cognitive patterns, including those attributed to chronic cerebral or systemic vascular disorders, trauma, and derangements of intracranial pressure and volume, including frontotemporal brain sagging syndrome.

Gender-Related Differences in Regional Cerebral Glucose Metabolism in Normal Aging Brain.

Objectives: This study was aimed to investigate the gender-related differences of regional cerebral glucose metabolism in healthy people along the age using 18F-FDG PET/CT.Methods: We recruited 344 healthy volunteers, including 217 males and 127 females (age range: 40–89 years old). All subjects underwent fluorine-18 fluorodeoxyglucose(18F-FDG) positron emission tomography (PET). All the data were divided into four groups for every 10 years old. Each participant was carefully screened from PET, MR, and other examinations in order to exclude the abnormalities, such as neurodegenerative or psychiatric disorders, alcohol/abuse, cerebral vascular disorders, metabolic diseases like diabetes mellitus and hyperthyroidism, and other systemic malignancies. The 40–50 years old group was set as the baseline group. Statistical parametric mapping (SPM) analysis was employed to illustrate the differences among groups.Results: Compared to the baseline group, whether in a cohort or different gender groups, the decrease of brain glucose metabolism was shown in the bilateral frontal lobe, anterior cingulate gyrus, and the bilateral temporal lobe. In males, the regions of decreased metabolism were bilateral frontal lobe, caudate nucleus, and cingulate gyrus, whereas that of females were left occipital lobe, cerebellum, and the thalamus. However, the overall decrease of brain metabolism in men and women began from the age of 60s, an aggravated decrease from 70s was only observed in males.Conclusion: (1) An obviously decreased brain metabolism was found from 60 years old, especially in the bilateral frontal lobe, bilateral temporal lobe, and inferior cingulate gyrus; (2) We found specific brain metabolic differences between genders, including the caudate nucleus region in males and the occipital lobe region in females; and (3) The aging trend is different between genders.

Measuring hyperemic response to light flicker stimulus using continuous laser speckle flowgraphy in mice

Alterations in neurovascular coupling have been associated with various ocular, cerebral, and systemic vascular disorders. In the eye, changes in vessel caliber by dynamic vessel analysis have been used to measure neurovascular coupling following a light flicker stimulus. Here, we present a new protocol for quantifying light-flicker induced hyperemia in the C57/Bl6J mouse retina using laser speckle flowgraphy (LSFG). Our protocol was adapted from protocols used in human subjects. By acquiring continuous time series data, we detected significant increase in blood flow. These responses are maintained with low variability over multiple imaging sessions, indicating these methods may be applied in serial studies of neurovascular coupling.

About brain disorders in acute coronary insufficiency

In acute coronary insufficiency, cerebral vascular disorders are not uncommon. NK Bogolepov calls the resulting states a combined coronary-cerebral crisis.

A Traditional Review of Sickle Cell Disease and the Associated Onset of Dementia: Hematological and Neurocognitive Crossroads.

Sickle cell trait and disease are potential risk factors for dementia and cognitive dysfunction in African Americans, as are genetic variants. This illness affects around 300 million people globally. Due to its ability to defend against severe malaria, it represents an evolutionary survival advantage. It has been shown that sickle cell disease and trait are independent risk factors for the prevalence and incidence of albuminuria and chronic renal disease. Sickle cell anemia impairs cognitive performance in people with minimal or mild manifestations of the genetic blood disorder, owing mostly to its cerebrovascular implications. Similarly, various cerebral minor vascular disorders, such as silent cerebral infarcts, have been linked to the sickle cell trait, which is associated with impaired cognitive ability. It has been found that patients with sickle cell disease have a significantly decreased subcortical and cortical brain volume. Adults and children with sickle cell disease have been documented to have attention-related issues, particularly reduced sustained attention.

CLINICAL COURSE, TREATMENT AND PROGNOSIS OF CEREBROVASCULAR DISORDERS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Type 2 diabetes mellitus (DM2) significantly increases the risk of stroke, dementia, and other cognitive and mental disorders. Atherosclerotic type of cardiovascular disorders (CVD) is the main cause of death in patients with DM2. Aim. In this review, we aimed to outline risk factors, clinical characteristics and outcomes of stroke in patients with DM2. The obtained information can be used to improve prevention, early diagnosis, and treatment of cerebral vascular disorders in DM2. Materials and Methods. We conducted a systematic review of prognostic and risk factors of cerebral vascular disorders in DM2. Our search included 50 articles from PUBMED published in the last few years. We compared statistical data from Azerbaijan with those from other countries. Results. Hyperglycemia, obesity, insulin resistance and arterial hypertension (AH) are all risk factors of brain microvascular dysfunctions in patients with diabetes mellitus. Furthermore, obesity, AH, dyslipidemias, smoking and genetic predisposition to CVD, chronic kidney disorders, and albuminuria are all risk factors of cardiovascular disorders in DM2. The possible outcomes can be a stroke, cognitive dysfunction, and depressive disorders. For Azerbaijan, main risk factors is an atherosclerotic type of CVD. Conclusion. Due to the high socio-economic burden of disease there is an urgent need in new approaches aimed at prevention, early diagnosis and treatment of cerebral vascular disorders in patients with DM2 in Azerbaijan.

Development of Novel Therapeutics Targeting the Blood-Brain Barrier: From Barrier to Carrier.

The blood–brain barrier (BBB) is a highly specialized neurovascular unit, initially described as an intact barrier to prevent toxins, pathogens, and potentially harmful substances from entering the brain. An intact BBB is also critical for the maintenance of normal neuronal function. In cerebral vascular diseases and neurological disorders, the BBB can be disrupted, contributing to disease progression. While restoration of BBB integrity serves as a robust biomarker of better clinical outcomes, the restrictive nature of the intact BBB presents a major hurdle for delivery of therapeutics into the brain. Recent studies show that the BBB is actively engaged in crosstalk between neuronal and the circulatory systems, which defines another important role of the BBB: as an interfacing conduit that mediates communication between two sides of the BBB. This role has been subject to extensive investigation for brain‐targeted drug delivery and shows promising results. The dual roles of the BBB make it a unique target for drug development. Here, recent developments and novel strategies to target the BBB for therapeutic purposes are reviewed, from both barrier and carrier perspectives.

Blood Pressure and Risk of Cognitive Impairment: The Role of Vascular Disease in Neurodegeneration.

(1) Background: Both cerebral vascular disorders and cognitive decline increase in incidence with age. The role of cerebral vascular disease and hemodynamic changes in the development of cognitive deficits is controversial. The objective of this study was to assess the cardiovascular response during cardiac stress testing in neurologically asymptomatic individuals who developed cognitive impairment several years after previous cardiac stress testing. (2) Methods: This was a retrospective cohort study of patients who underwent cardiac stress testing between January 2001 and December 2010. Patients were followed up until May 2015, and we selected those who developed cognitive dysfunction including dementia, mild cognitive impairment, and subjective cognitive decline, after the stress test. Heart rate and blood pressure both at rest and at peak exercise, and the mean R-R interval at rest were recorded. For each patient who developed cognitive impairment, we selected one matched control who did not show cognitive decline by the end of the follow-up period. (3) Results: From the cohort of 7224 patients, 371 developed cognitive impairment; of these, 186 (124 men) met the inclusion criteria, and 186 of the other patients were selected as matched controls. During follow-up, cognitive impairment appeared 6.2 ± 4.7 years after the cardiac stress test. These patients who had subsequently developed cognitive impairment had significantly lower at-rest systolic, diastolic, and mean blood pressure than controls (p < 0.05). Further, compared with controls, their maximum heart rate was significantly higher at peak exercise. (4) Conclusion: The results from this study suggest that differences in cardiovascular response to stress might be present in individuals who develop cognitive decline. These findings challenge the possibility of assessing blood pressure and heart rate variability at rest and during cardiac stress as potential risk factors associated with cognitive impairment.

Epidemiological survey of the psoriasis patients in the Japanese Society for Psoriasis Research from 2013 to 2018.

In Japan, the Japanese Society for Psoriasis Research (JSPR) has been conducting annual epidemiological surveys of patients with psoriasis since 1982. The aim of this study was to conduct a recent epidemiological analysis of the psoriasis patients who were enrolled in the JSPR from 2013 to 2018. A total of 15 287 cases were enrolled from 132 medical institutions, out of which 65.3% (9989 cases) were male and 34.7% (5298 cases) were female. Approximately 50.0% of the cases had past history and comorbidities, such as hypertension (42.0%), dyslipidemia (30.0%), diabetes mellitus (23.7%), hyperuricemia (15.1%), cardiovascular disease (6.0%), and cerebral vascular disorders (6.0%). There was a yearly increase in the use of corticosteroid/vitamin D3 combinations and apremilast for treating psoriasis. In contrast, the use of phototherapy gradually decreased. From 2013 to 2018, approximately 18.6% of the cases were treated with biologics, such as infliximab (17.6%), adalimumab (23.3%), ustekinumab (21.4%), secukinumab (11.6%), ixekizumab (7.6%), brodalumab (6.3%), and guselkumab (4.3%). In the past decade, the biologics have changed the treatment and management of psoriasis. This survey includes significant information regarding the recent perspective of psoriasis in the Japanese Society, especially focusing on the treatment trends after the introduction of biologics.

Multifunctional memantine nitrate significantly protects against glutamate-induced excitotoxicity via inhibiting calcium influx and attenuating PI3K/Akt/GSK3beta pathway

Overactivation of N-methyl-D-aspartate (NMDA) receptors has been associated with neurodegenerative disorders such as Alzheimer’s disease (AD), cerebral vascular disorders and amyotrophic lateral sclerosis (ALS). We have previously designed and synthesized a series of memantine nitrate and some of them have shown vessel dilatory effects and neuroprotective effects; however, the detailed mechanisms have not been elucidated. In this study, we further demonstrated that memantine nitrate-06 (MN-06), one of the novel compounds derived from memantine, possessed significant neuroprotective effects against glutamate-induced excitotoxicity in rat primary cerebellar granule neurons (CGNs). Pretreatment of MN-06 reversed the activation of GSK3b and the suppression of phosphorylated Akt induced by glutamate. In addition, the neuroprotective effects of MN-06 could be abolished by LY294002, the specific phosphatidylinositol 3-kinase (PI3-K) inhibitor. Ca2+ imaging shown that pretreatment of MN-06 prevented Ca2+ influx induced by glutamate. Moreover, MN-06 might inhibit the NMDA-mediated current by antagonizing NDMA receptors, which was further confirmed by molecular docking simulation. Taken together, MN-06 protected against glutamate-induced excitotoxicity by blocking calcium influx and attenuating PI3-K/Akt/GSK-3b pathway, indicating that MN-06 might be a potential drug for treating neurodegenerative disorders.

PERBEDAAN INFORMASI CITRA ANATOMI SEKUEN DIFFUSION WEIGHTED IMAGING (DWI) ANTARA PENGGUNAAN PROPELLER DENGAN TANPA PROPELLER PADA PEMERIKSAAN MRI BRAIN DENGAN KASUS STROKE

Background: Stroke is a brain disease where an acute nerve function is occurred due to the cerebral vascular disorders. To establish a diagnosis the stroke, it can be identified by employing the Diffusion Weighted Imaging (DWI) sequence in the MRI examination. Artifacts still exist on the MRI image which in turn reduce the resolution when using the DWI sequence. Adding the PROPELLER data acquisition method in the DWI sequence possibly improves the quality of brain images. The purpose of this study is to know the difference on the quality of anatomical image information between the DWI sequences with PROPELLER and without PROPELLER methods, and to determine adequate anatomical image appearance that created in amongst of the two methods, specifically for the stroke disease.Methods: this research is quantitative research with experimental approach. This study was conducted using MRI 1.5 T at Bethesda Hospital Yogyakarta. Data were 16 images from 8 patients using DWI sequences using PROPELLER without PROPELLER on MRI Brain examination with stroke. The results of the image were evaluated on 7 criteria: cortex cerebri, basal ganglia, thalamus, pons, cerebellum, stroke (infarction) and artifacts using questionnaires given to 3 respondents. Data analysis was done by Wilcoxon test to know the difference of anatomical image information on DWI sequence using PROPELLER without PROPELLER and to know better anatomical image information from both sequences seen from mean rank value.Results: The results shown, there is a significant difference on the quality of anatomical image information and the artifacts between the use of DWI sequence with and without PROPELLER methods ( 0.05). Based on the mean rank results, the DWI PROPELLER sequence has a higher mean rank value 4.50 compared to the DWI sequence without PROPELLER 0.00.Conclusions: The DWI PROPELLER sequence has better image results compared to the DWI sequence without PROPELLER.

Abstract TP446: Rosuvastatin Improves Cerebral Hemodynamics in Rats With Chronic Cerebral Hypoperfusion

Objective: Chronic cerebral hypoperfusion (CCH) is a common consequence of various cerebral vascular disorders, hemodynamics and blood composition changes, which can lead to neurodegenerative injury and cognitive dysfunction. Therefore, it is important to take measures to prevent or reverse its development. Methods: Eighty Sprague-Dawley rats were randomly divided into five groups: Sham group, Vehicle groups (2-week group and 4-week group), Rosuvastatin-treated groups (2-week group and 4-week group). Both vehicle and treated group rats were treated with bilateral common carotid artery occlusion (BCCAO). Then rats in the treated group were intravenously injection with rosuvastatin (0.2 mg/kg/day) daily for 14 days beginning 24 hours after BCCAO. The vehicle groups were given the same amount of saline. The MRI ASL technique was used to scan cerebral blood flow (CBF) at pre-occlusion, BCCAO, 1, 2, 3, and 4 weeks after operation. Morris water maze test detected spatial memory abilities of the treated and vehicle rats after BCCAO. Immunofluorescence staining was used to detect the expression of CD34, GFAP, NeuN and Caspase-3 positive cells in hippocampus. Results: CBF decreased significantly after BCCAO in both rosuvastatin-treated and vehicle groups and then increased gradually. The CBF of the treated group was basically recovered to baseline levels at 1 or 2 weeks after BCCAO. But it took the vehicle group 4 weeks to restore to baseline. The vertebral artery (VA) diameter of the treated group was greater than that of the vehicle group (p&lt;0.05), and the recovery of CBF and the dilation of VA were more evident during the administration period. Similarly, the escape latency of the treated group rats was also less than the vehicle group in Morris Water Maze test. In addition, the number of CD34 + and NeuN + cells in the hippocampus of the treated group was more than that in the vehicle group (p&lt;0.01), while the number of GFAP + and Caspase-3 + cells was less than in the vehicle group (p&lt;0.01). Conclusion: Rosuvastatin can accelerate the recovery of cerebral blood flow in CCH rats, which may be related to the dilation of VAs and angiogenesis; and its effects on reducing astrocyte activation and neuroprotection may help to ameliorate cognitive dysfunction in CCH rats.

Clinical and neuroimaging correlates among cohorts of cerebral arteriostenosis, venostenosis and arterio-venous stenosis.

The purpose of this study was to discriminate the clinical and imaging correlates of cerebral arterial stenosis (CAS), venous stenosis (CVS) and arterio-venous stenosis (CAVS) in the clinical setting. Patients were classified into three groups: CAS (n = 75), CVS (n=74) and CAVS (n=67). Focal neurological deficits were the prominent presenting symptoms in CAS group, while venous turbulence related symptoms were common in both CVS and CAVS group. Risk factor analysis showed the OR (95%CI) for diabetes, male gender and age in CAS vs. CVS group were 13.67(2.71, 68.85), 6.69(2.39, 18.67) and 1.07(1.03, 1.12) respectively. Male gender, diabetes and age in CAVS vs. CAS groups were 0.27(0.11, 0.63), 0.26(0.10, 0.67) and 1.09(1.04, 1.14) respectively, while age in CAVS vs. CVS group was 1.11(1.07, 1.15). The white matter lesions (WMLs) in CAS group varied in size, with clear boundaries asymmetrically distributed in bilateral hemispheres. CVS-induced WMLs revealed a bilaterally symmetric, cloudy-like appearance. The cerebral perfusion was asymmetrically reduced in CAS but symmetrically reduced in CVS group. The clinical characteristics and neuroimaging presentations were different among patients with CAS, CVS and CAVS. We recommended for aged patients, both arterial and venous imaging should be considered in diagnosis of cerebral stenotic vascular disorders.

Specific risk factors for cerebrovascular disorders in patients with chronic kidney disease in the pre-dialysis period

Cerebral vascular disorders are one of the leading causes of disability and mortality in patients with chronic kidney disease (CKD). The article presents the currently available data on risk factors (RF) for the development of cerebrovascular disorders in pre-dialysis patients with CKD. Two groups of RF are identified: traditional and non-traditional (specific). Traditional RF, which include arterial hypertension, diabetes mellitus and hypercholesterolemia, independently affect the cerebral vascular bed and get worse against the background of CKD. Specific RF is associated with features of the CKD pathogenesis. It includes increased blood levels of homocysteine, β2-microglobulin, impaired calcium-phosphorus metabolism, accumulation of uremic toxins and toxins of intestinal bacteria, anemia and other factors. In the present review, special attention is paid to specific RF and pathogenetic mechanisms of the development of cerebrovascular disorders in predialysis patients with CKD. Timely detection of cerebral risk factors may lead to the improvement of early diagnosis and prevention of cerebral vascular disorders, optimization of therapy for patients with CKD.