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Cerebral microbleeds (CMB) are considered a marker of an underlying hemorrhage-prone small vessel vasculopathy. The brain changes that accompany CMB may be a direct consequence of the CMB, of an underlying vasculopathy, or of risk factors associated with CMB or the underlying vasculopathies that cause CMB. This chapter reviews data associating CMBs with other neuroimaging findings. The relationships between CMBs and brain infarcts, hemorrhage and brain atrophy is discussed in general and in the context of specific small vessel diseases. CMBs are more frequent in patients with neuroimaging findings of white matter lesions (WML) and lacunar infarctions. By contrast, CMBs are not independently associated with brain atrophy, probably because the actual tissue damage directly caused by CMBs is minimal. These observations are consistent with the concept that CMBs are one of several neuroimaging markers of small vessel arterial disease.
Behçet's disease (BD) is a multisystemic inflammatory disorder of unknown etiology, and neurologic involvement is one of the major clinical features. When the clinicopathological and neuroradiological findings are combined, two different patterns of central nervous system (CNS) involvement in BD can be established: parenchymal and neurovascular. Neurologic involvement is one of the most devastating manifestations of BD. This involvement may occur primarily within the nervous parenchyma (n-BD) or secondarily in the cerebral vascular system (vasculo[angio]-BD). Thrombosis of cerebral large veins and sinuses is the most common feature of vasculo-BD, although thrombosis of the vena cava and portal vein may also occur in one third of these patients. BD is usually included among the systemic vasculitides but documented cerebral arteritis is extremely rare and even a debatable mechanism for CNS involvement. Cerebrovascular complications of BD are rarer than parenchymal involvement of the CNS and aseptic meningitis.
Evidence from cross-sectional studies suggests a link between cerebral age-related white matter changes and depressive symptoms in older people, although the temporal association remains unclear.
To investigate age-related white matter changes on magnetic resonance imaging (MRI) as an independent predictor of depressive symptoms at 1 year after controlling for known confounders.
In a pan-European multicentre study of 639 older adults without significant disability, MRI white matter changes and demographic and clinical variables, including cognitive scores, quality of life, disability and depressive symptoms, were assessed at baseline. Clinical assessments were repeated at 1 year.
Using logistic regression analysis, severity of white matter changes was shown to independently and significantly predict depressive symptoms at 1 year after controlling for baseline depressive symptoms, quality of life and worsening disability (P<0.01).
White matter changes pre-date and are associated with the development of depressive symptoms. This has implications for treatment and prevention of depression in later life.
Vascular dementia (VaD) is the second most common cause of dementia with a frequency ranging from 15% to 25% in autopsy and epidemiological studies (Tomlinson et al., 1970; Stevens et al., 2002). In addition, dementia is observed a few months post-stroke with prevalence as high as 25–33%, and about two-thirds of these patients meet the criteria of VaD (Tatemichi et al., 1993; Pohjasvaara et al., 1998). VaD may be a preventable type of dementia since it is due to vascular pathology and usually concerns patients with modifiable vascular risk factors. The diagnosis of VaD has several implications, including a high risk of stroke recurrence and mortality (Tatemichi et al., 1994b; Moroney et al., 1997b). VaD is due to several vascular pathologies, the most frequent being small vessel disease responsible for lacunes and leukoaraïosis (reported in about 40% of poststroke dementia) and multiple territorial infarcts. Because of the vascular mechanisms of underlying lesions, VaD is characterized by the frequency of stroke history, abrupt onset, stepwise deterioration, and the early presence of non-cognitive signs such as motor and perceptual deficits, gait disorders, speech and swallowing disorders, and incontinence. However a third of autopsy-confirmed VaD did not report stroke history and about a quarter presented with a progressive worsening (Moroney et al., 1997a). Although the neuropsychological pattern was found to be variable in an autopsy-confirmed VaD (Reed et al., 2004), most studies highlighted the prominence of executive dysfunction and response slowing.
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