Patterns of cerebral blood flow reduction in patients with ischemic leukoaraiosis

O’Sullivan, Michael; Lythgoe, David J.; Pereira, Anthony; Summers, Paul; Jarosz, J.; Williams, Steven; Markus, Hugh S.

doi:10.1212/wnl.59.3.321

Cited by 327 publications

(262 citation statements)

References 20 publications

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“…An alternate explanation for poor outcomes in patients with leukoaraiosis may be chronic cerebral hypoperfusion that results in reduced cerebral ischemic resilience and thus greater final lesion volumes, 20 which are a known outcome predictor after EST. 21 Indeed, we and others have previously shown that leukoaraiosis severity is associated with a larger ischemic core, mismatch lost, and final infarct volume, supporting this hypothesis.…”

Section: Multivariable Logistic Regression Analysis Of Factors Indepementioning

confidence: 99%

Leukoaraiosis Predicts a Poor 90-Day Outcome after Endovascular Stroke Therapy

Zhang¹,

Puri²,

Khan

et al. 2014

AJNR Am J Neuroradiol

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Section: Multivariable Logistic Regression Analysis Of Factors Indepementioning

confidence: 99%

Leukoaraiosis Predicts a Poor 90-Day Outcome after Endovascular Stroke Therapy

Zhang¹,

Puri²,

Khan

et al. 2014

AJNR Am J Neuroradiol

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“…The tortuosity of some of these arterioles leads to losses in hemodynamic kinetic energy [14]. Studies with MRI [15] and PET [16,17] have found decreased blood flow in the white matter of subjects with LA, and the blood flow was even reduced in normal-appearing white matter [15]. Thus, the vascular pathology and blood flow changes suggest that LA results from chronic ischemia [5,8,[16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Vascular dementia in leukoaraiosis may be a consequence of capillary loss not only in the lesions, but in normal-appearing white matter and cortex as well

Brown

Moody

Thore

et al. 2007

Journal of the Neurological Sciences

145

129

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We investigated capillary density in 12 subjects with leukoaraiosis (LA), in 9 age-matched normal subjects, in 7 cases of Alzheimer's disease (AD), and 4 after whole-brain irradiation for brain tumors. In the LA study (which as been published), autopsy brains were evaluated by MRI. The presence of LA was indicated by confluent or patchy areas of hyperintensity in the deep white matter. We employed a stereology method using computerized image processing and analysis to determine microvascular density. Afferent vessels (arterioles and capillaries, but not veins or venules) were stained for alkaline phosphatase in 100 μm thick celloidin sections. Microvascular density in LA lesions in the deep white matter (2.56%) was significantly lower than in the corresponding deep white matter of normal subjects (3.20%, p = 0.0180). LA subjects demonstrated decreased vascular density at early ages (55 -65 years) when compared to normal subjects. Our findings indicate that LA affects the brain globally, with capillary loss, although the parenchymal damage is found primarily in the deep white matter. In ongoing studies of the deep white matter in AD brains, we found a pattern of decreased vascular density compared to normal, as well as an age-related decline. In the four irradiated brains, we found very low vessel densities, similar to those found in LA, without an additional age-related decline.

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“…CKD is a salt-avid state, and the salt overload aggravates both HTN and systemic inflammation autoregulation with subsequent transmittal of increased systemic pressure into the glomerulus and cerebral capillary beds. Loss of autoregulation also predisposes to ischemic events related to decrease of regional cerebral blood flow (CBF) [19,20]. Hypertension worsens arteriolosclerosis, creating a vicious cycle that perpetuates end organ damage.…”

Section: Accelerated Arteriolosclerosis With Impaired Autoregulationmentioning

confidence: 99%

Neurocritical Care for Patients with Kidney Dysfunction

Park¹

2017

J Neurocrit Care

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Chronic kidney disease (CKD) is an independent risk factor for the development of cerebrovascular disease, particularly small vessel disease which can manifest in a variety of phenotypes ranging from lacunes to microbleeds. Small vessel disease likely contributes to cognitive dysfunction in the CKD population. Nontraditional risk factors for vascular injury in uremia include loss of calcification inhibitors, hyperphosphatemia, increased blood pressure variability, elastinolysis, platelet dysfunction, and chronic inflammation. In this review, we discuss the putative pathways by which these mechanisms may promote cerebrovascular disease and thus increase risk of future stroke in CKD patients.

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Patterns of cerebral blood flow reduction in patients with ischemic leukoaraiosis

Cited by 327 publications

References 20 publications

Leukoaraiosis Predicts a Poor 90-Day Outcome after Endovascular Stroke Therapy

Leukoaraiosis Predicts a Poor 90-Day Outcome after Endovascular Stroke Therapy

Vascular dementia in leukoaraiosis may be a consequence of capillary loss not only in the lesions, but in normal-appearing white matter and cortex as well

Neurocritical Care for Patients with Kidney Dysfunction

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