Risk Factor For Cerebrovascular Disorders Research Articles

Mechanisms linking obesity and its metabolic comorbidities with cerebral grey and white matter changes.

Obesity is a preventable risk factor for cerebrovascular disorders and it is associated with cerebral grey and white matter changes. Specifically, individuals with obesity show diminished grey matter volume and thickness, which seems to be more prominent among fronto-temporal regions in the brain. At the same time, obesity is associated with lower microstructural white matter integrity, and it has been found to precede increases in white matter hyperintensity load. To date, however, it is unclear whether these findings can be attributed solely to obesity or whether they are a consequence of cardiometabolic complications that often co-exist with obesity, such as low-grade systemic inflammation, hypertension, insulin resistance, or dyslipidemia. In this narrative review we aim to provide a comprehensive overview of the potential impact of obesity and a number of its cardiometabolic consequences on brain integrity, both separately and in synergy with each other. We also identify current gaps in knowledge and outline recommendations for future research.

Gender features in cerebrovascular disorders in different age groups

Introduction. Numerous studies of ischaemic stroke pathogenesis allowed to develop the modern concept of the causes of ischaemic stroke. Risk factors are of primary importance in the development of cerebrovascular disorders (CVD). Study aim – to examine the representation of risk factors for CVD and the causes of ischaemic stroke in the territory of the internal carotid artery, taking into account age and gender differences. Materials and methods. We examined 331 (47.7%) men and 363 (52.3%) women aged 25–89 years with chronic CVD and ischaemic stroke in the territory of the internal carotid artery. Of the 279 patients with ischaemic stroke in the territory of the internal carotid artery, 57.7% were male and 42.3% were female. The majority of patients with ischaemic stroke were aged between 60 and 74 years, both among the men (72; 57.6%) and among the women (53; 42.4%). Results. Men were more likely to have arterial hypertension (64.4% vs. 49.6%; p <0.001), a history of transient ischaemic attacks (16.6% vs. 8.6%; p =0.002) and ischaemic stroke (14.5% vs. 9.1%; p =0.033), coronary heart disease (post-infarction cardiosclerosis) (13.9% vs. 7.2%; p =0.004), and to smoke (42.3% vs. 20.2%; p <0.001) and to consume excess alcohol (14.8% vs. 2.5%; p <0.001) than women. Atherothrombotic stroke was more common in men than in women (38.1% versus 21.2%; p =0.003). Women were more likely than men to have a cardioembolic stroke (39.0% vs. 21.9%; p =0.002) and a stroke due to internal carotid artery dissection (6.8% vs. 1.3%; p =0.020). In the 60–74-year age group, men were more likely to have atherothrombotic stroke (49.3% vs. 22.6%; p =0.002), while women were more likely to have cardioembolic stroke (47.2% vs. 26.8%; p =0.019) or a lacunar infarct (17% vs. 4.2%; p =0.017). Conclusion. Gender and age differences were found in the frequency of risk factors for CVD and in subtypes of ischaemic stroke. Men are more likely than women to have arterial hypertension, a history of transient ischemic attacks and stroke, coronary heart disease, and to smoke and to consume excess alcohol. Ischaemic stroke in the territory of the internal carotid artery occurs more often in older men and women. Among the ischaemic stroke subtypes in that age group, atherothrombotic stroke was more common in men, while cardioembolic and lacunar infarcts were more common in women.

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.

Prevalence of the risk factors of cerebrovascular disorders in the capital city residents aged 40–59: a clinical and epidemiological study

Introduction. Circulatory system diseases and cerebrovascular disorders are among the principal causes of morbidity and mortality in the Russian Federation. Updated information on prevalence and structure of the risk factors is needed to elaborate populationwide prevention measures. The aim is to assess the prevalence of the risk factors for cerebrovascular disorders in the working-age population of capital city residents and stratification of subjects into the risk groups using clinical scales for comprehensive evaluation. Materials and methods. Thorough screening of the open population aged 40–59 was carried out at one outpatient medical service facility in Moscow in 2011–2012: 376 subjects (156 men, 220 women). The analysis took into account gender and agerelated differences (in the age groups of 49–49 and 50–59-yearold adults). Results. We obtained the data on prevalence of the major risk factors of cerebrovascular disorders, men/women (%): family history – 38.5/55.9, smoking 40.4/25.9, low physical activity – 48.4/49.5, class 1 obesity – 21.8/21.4, class 2 and 3 obesity – 6.4/12.7, elevated serum cholesterol levels – 32.7/43.2, elevated serum triglyceride levels – 23.1/15.0, hypertension – 48.1/45.0, type 2 diabetes – 3.8/2.7, increased intima-media thickness in the carotid and femoral arteries – 44.9/65.9, atherosclerotic plaques of any localization (carotid and/or femoral arteries) 62.8/40.5, and >30% atherosclerotic stenosis of any localization – 12.2/7.7. Prevalence of the risk factors in the population and, in some cases, their severity increased with age (before and after age 50) up to 1.5–2 fold. When using SCORE and Stroke Riskometer ™ tools for stratification, 8.6% and 39.3% subjects fell into the high-risk groups, respectively. Conclusion. Working-age capital city residents in the 40–59 years cohort show high prevalence of risk factors for cardiovascular and cerebrovascular disorders with the first significant rise of prevalence after reaching a 50-year age border; hypertension, low physical activity and increased intima-media thickness hold leading positions. The newest Stroke Riskometer™ appears to be the most relevant tool for the risk assessing as it has a variety of undoubted advantages compared to other clinical instruments.

Clinical Significance of Hyperhomocysteinemia Between Alzheimer’s Disease and Vascular Dementia

Background: Recent research has shown that risk factors for cerebrovascular disorders are also causes of dementia. Of these risk factors, hyperhomocysteinemia is well known to be positively correlated with all types of dementias including Alzheimer’s disease (AD) and vascular dementia (VaD). But it is not know if there is a difference in the concentration of homocysteine in AD and VaD. We analyzed the homocysteine concentrations in AD and VaD and investigated the relationship between homocysteine and the progression of these two dementias. Methods: A total of 193 patients to the dementia clinic at our hospital were enrolled. Fifty-four patients had AD and 48 patients had VaD. The remaining patients were the healthy control. Data for analysis consisted of the results of neuropsychological tests and homocysteine levels. Results: Homocysteine levels were higher in AD and VaD patients than in healthy subjects, and no statistical difference was seen between AD and VaD. With lower mini-mental state examination scores, the homocysteine concentration increased significantly in VaD, but not in AD. The homocysteine concentration and the sum of box of clinical dementia rating were positively correlated in both AD and VaD. Other neuropsychological tests had no correlation with the homocysteine level. Conclusion: This study suggests that hyperhomocysteinemia, resulting in inflammation of vessel walls and oxidative stress, is a risk factor for both AD and VaD. However, our results did not clarify if hyperhomocysteinemia is related to the progression of dementia symptoms.

A Case of Wallenberg Syndrome due to Vertebral Artery Dissection

Vertigo and nausea suddenly developed in a 33-year-old man without a relevant medical history. He reported that he had had throbbing headaches for 1 month. On admission, neurological examination revealed dysarthria, right Horner syndrome, and hypoesthesia of the left side of the face and of the left side of the body below the neck. Initial magnetic resonance imaging of the brain showed no areas of abnormal intensity on diffusion-weighted imaging, but magnetic resonance angiography showed a stringlike structure of the right vertebral artery. Acute infarction due to right vertebral artery dissection was diagnosed. Heparin sodium was immediately administered intravenously. Three days after symptom onset, magnetic resonance imaging-diffusion-weighted imaging of the brain clearly showed a high-intensity area in the right lateral medulla oblongata, a finding that confirmed the clinical diagnosis. This case emphasizes that vertebral artery dissection should be considered in patients with vertigo, especially young patients without risk factors for cerebrovascular disorders. The clinical history and neurological examination remain fundamental aspects of patient assessment in the era of advanced neuroimaging.

Increased tissue factor pathway inhibitor and homocysteine in Alzheimer's disease

We investigated the possible involvement of vascular damage in the pathogenesis of Alzheimer's disease (AD), by assessment of plasma levels of tissue factor pathway inhibitor (TFPI), a serine protease inhibitor induced by endothelial injury, and homocysteine (Hcy), a known risk factor for cerebrovascular disorders, folate levels were also measured. 110 probable AD, 38 mild cognitive impairment, 31 patients affected by idiopathic Parkinson's disease (without dementia) and 100 healthy controls, who displayed no vascular disorders were enrolled. TFPI and Hcy were significantly higher in AD patients with respect to other groups. The levels of TFPI and Hcy were positively correlated in hyperhomocysteinemic AD and mild cognitive impairment subjects, and were negatively correlated with folate levels. Our findings suggest that an impairment of endothelial function associated with high Hcy levels may occur in AD patients, despite the absence of manifest cerebrovascular lesions. Therefore, TFPI may represent a candidate marker of endothelial damage in AD and might be used for the identification and monitoring of patients that would benefit from folate supplementation treatment.

回転性めまいで発症した若年性Ｗａｌｌｅｎｂｅｒｇ ｓｙｎｄｒｏｍｅの２症例

We report two young patients of Wallenberg syndrome who presented with acute vertigo as the initial symptom. Neither Case 1, an 8-year-old girl, nor Case 2, a 29-year-old man, showed any abnormal findings on the initial magnetic resonance imaging (MRI) on day 1. In addition to nystagmus, several neurological signs became positive during the clinical course. Finally, the diagnosis of Wallenberg syndrome was made in both cases based on the detection of a lateral medullary infarction in a follow-up MRI conducted on day 4. Stroke should be considered in the differential diagnosis of acute vertigo, even in young patients without risk factors for cerebrovascular disorders, such as hypertension, diabetes and/or hyperlipidemia. Since MRI may show no abnormalities in the very early stages of stroke, neurological examinations are useful to establish the diagnosis in cases presenting with vertigo induced by brain stem or cerebellar infarction.

Increased Intima Media Thickness and Atherosclerotic Plaques in the Carotid Artery as Risk Factors for Silent Brain Infarcts

The presence of silent cerebral infarcts (SCIs), defined as lesions > or = 3 mm in diameter on magnetic resonance imaging (MRI), is considered a predictor of symptomatic cerebrovascular disorders (CVDs). Similarly, SCI-like lesions < 3 mm in diameter, lesions which often occur in the deep white matter and basal ganglia, also may be a risk factor for CVD. This study evaluated the relationships between SCI and SCI-like brain lesions, as defined by MRI, and 2 findings on extracranial carotid ultrasonography: intima-media thickness (IMT) and atherosclerotic plaque. We studied data obtained by carotid ultrasonography and cerebral MRI in 448 consecutive subjects without a history of stroke who had undergone comprehensive brain screening (mean age, 51.1 years). The subjects were classified into 4 groups according to the presence of increased (> or = 1 mm) IMT (I) and plaque (P). A total of 110 subjects demonstrated increased IMT (24.6%), and 54 subjects had increased plaque (12.1%). SCI-like lesions were found in 38 subjects (8.5%); single SCI, in 24 (5.4%); and multiple SCIs, in 51 (11.4%). Frequencies of SCI-like lesion(s), single SCI, and multiple SCIs were 6.1%, 12.2%, and 8.7%, respectively, in the I(-)P(-) group; 14.6%, 22.0%, and 13.4% in the I(+)P(-) group; 7.7%, 30.8%, and 26.9% in the I(-)P(+) group; and 17.9%, 39.3%, and 21.4% in the I(+)P(+) group. Multivariate analysis found that the presence of carotid plaques was significantly associated with (1) SCI-like lesion(s) and SCI (odds ratio [OR] = 2.20; 95% confidence interval [CI] = 1.17-4.34), (2) single and multiple SCI (OR = 2.33; 95% CI = 1.16-4.67), and (3) multiple SCIs (OR = 2.31; 95% CI = 1.06-5.03). However, the presence of increased carotid IMT was not significantly associated with any of these 3 categories. Coexistence of increased IMT and plaque was more strongly correlated with SCI than with either lesion alone.

Neurological disorders associated with Mycoplasma pneumoniae infection.

Neurological syndromes caused by Mycoplasma pneumoniae (MP) infection are occasionally reported in adults, usually in the post-infectious period, and three computed tomography documented cases have recently appeared in this journal. Here we present the cases of three young women with recent respiratory tract infection caused by MP some weeks prior to neurological complication documented by magnetic resonance imaging. Two cases suffered from demyelinating disorders of the central nervous system (CNS). The other case had a middle cerebral artery thrombosis, a rare complication of MP infection. Another potential risk factor for stroke in the latter case was the use of oral contraceptives. Recent infection with MP is discussed as a risk factor for cerebrovascular disorders and CNS demyelinating diseases.

Meta-analysis of hypertension as a risk factor of cerebrovascular disorders in Koreans.

This study was conducted to integrate the results of previous studies which evaluated hypertension as a risk factor for cerebrovascular disorders (CVD) in Koreans. We retrieved the Korean literature using a manual search and the English literature using the MEDLINE database concerning the relationship between hypertension and CVD in Koreans from 1980 to 1997. The overall effect size of hypertension as a risk factor of CVD was represented by common odds ratio (OR). Before the integration of each effect size, a heterogeneity test and a sensitivity test was conducted. The materials were nine published epidemiologic studies with a total of 2,271 cases of CVD. The common ORs (95% confidence interval) of overall CVD, hemorrhagic CVD and ischemic CVD associated with hypertension were 4.10 (3.56-4.71), 6.56 (4.92-8.80) and 3.28 (2.77-3.90), respectively. Thus, the common OR of hemorrhagic CVD associated with hypertension was significantly higher than that of overall or ischemic CVD. This suggests that hypertension is an important risk factor for overall CVD and its subtypes in Koreans. Due to the lack of reliable prospective studies, however, longitudinal study is required in this area.

Etiology of stroke in children

Although the risk factors for stroke in children are numerous and differ greatly from the causes of stroke in adults, a thorough diagnostic evaluation can identify one or more risk factors in most patients. Cardiac disorders and hemoglobinopathy are the most common causes of ischemic infarction, whereas various congenital anomalies of the blood vessels or defects in coagulation or platelet function are often found in children with intraparenchymal hemorrhage. More than one risk factor is commonly identified, especially in children with dural venous thrombosis. Identification of the underlying risk factors for cerebrovascular disorders in children is important because many of the risk factors can be treated, reducing the risk of subsequent strokes.

Cerebrovascular disorders and alcohol intake: preliminary results of a case-control study.

The role of alcohol as a risk factor for cerebral infarction and hemorrhage has been assesed in 200 middle-aged and elderly stroke patients and 200 controls matched for age, sex and hospital admission date. Computed tomographic brain scans were done in all but 10 of the stroke patients. Alcohol intake was reckoned on the 12 months preceding hospitalization and expressed in grams daily according to a standard nomogram. The Michigan Alcoholism Screening Test was used for the diagnosis of alcoholism. Cerebral infarction was present in 59% of the stroke patients and cerebral hemorrhage in 9%. The role of alcohol as risk factor for stroke proved to be small (Odds Ratio 1.86) and was practically lost after adjustment for the most common risk factors for cerebrovascular disorders (previous strokes, arterial hypertension, diabetes, obesity and hyperlipidemia). Our findings seem to suggest that alcohol is not an independent risk factor for stroke in the middle-aged and elderly. The data are, however, preliminary and are discussed in the light of methological problems.