Back Ground: Cerebral small vessel disease (CSVD) is a condition of clinical and neuroimaging presentations that arise mainly from damage to the brain's small perforating vessels causing lacunar type strokes, Intracranial hemorrhage and insidious significant deficits in gait, urinary and cognitive domains which are progressive in nature rTMS showed efficacy regarding improving gait and cognition in subcortical pathologies as Multiple Sclerosis, Parkinson disease and vascular dementia. rTMS exerts efficacy through enhancing neuroplasticity and in part modulating associated neuronal inflammation. Aim of work: Study the effect of High frequency rTMS on Cognitive symptoms among patients with cerebral small vessel disease with no acute stroke presentation. Patients and Methods: 40 patients are included, with MRI documented small vessel disease, symptomatic by either gait or cognitive or urinary symptoms or all. Randomized to 20 active and 20 sham groups, Active group received 6 sessions of high frequency Cz of intensity of 110% Motor Threshold. Sham group received 6 Sham sessions. Baseline line demographic data, vascular risk factors, radiological scales (Fazekas and Global cortical atrophy scale) were done to all patients, Baseline, post-sessions and 1 month follow up assesments were done regarding cognitive scales including FAB ( Frontal assessment Battery) and Adam Brook scale. Results: Comparing active group to sham group. Active rTMS has statistically significant improved FAB scores (P < 0.001) and Adam Brook scale scores (P < 0.001) Conclusion: our results suggested that High frequency Cz applied rTMS sessions showed statistically significant improvement in cognitive performance in patients with small vessel disease.

Background Cerebral arterial stenosis (CAS), in the absence of a structural lesion, can result in cognitive impairment that represents an ongoing contention among studies. Accordingly, we investigated cognitive functions in asymptomatic patients with CAS, using P300 which is a neurophysiological tool. We also compared cognition in intracranial stenosis (ICS) and extracranial stenosis (ECS). Methods Asymptomatic patients with CAS (≥ 70%) in the absence of structural brain lesions were categorized into ICS and ECS groups of 15 patients each, in addition to 15 normal controls. MRI, MRA, CT angiography, P300 analysis, Mini-Mental State examination (MMSE), Wisconsin Card Sorting Test (WCST), and Wechsler Memory Scale Test-Revised (WMST) were performed to all patients. Results Impairment on all cognitive scales ranged from 70 up to 100% among CAS group. Prolonged p300 latency and reaction time correlated with worse performance on WMST (p = 0.02), while lower amplitude and decreased accuracy correlated with more errors on WCST (p = 0.01). ICS scores on WCTS were lower than those of ECS group (p = 0.001), while ECS had a longer reaction time (p = 0.02) and lower scores on MMS and WMST than those of ICS group (p = 0.03). Conclusion Patients with asymptomatic CAS had a high prevalence of cognitive dysfunction which places them at risk of higher morbidity. ICS group showed impairment on executive functions, while the ECS group showed predilection to memory and information processing dysfunction.

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