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Cerebral amyloid angiopathy (CAA) occurs commonly in the elderly population. It results in thickening of the vessel wall, primarily in small arteries and arterioles of the leptomeninges and cerebral cortex. Primary intracerebral hemorrhage (ICH) in the elderly is the result of disease of the small cerebral vessels, in particular hypertensive vasculopathy or CAA. The CAA-related cerebral microbleeds (CMBs), like other types of microbleed, consist primarily of macrophages containing hemosiderin, a degraded form of ferritin. The most commonly employed criteria for diagnosis of CAA-related ICH are based on neuropathological examination or, more commonly, characteristic neuroimaging findings. Despite its high age-related prevalence, CAA has been difficult to detect non-invasively and is, likely to be underestimated in its effects on the aging process. The occurrence of CAA-related CMBs has emerged as the most useful diagnostic marker for CAA in clinical practice and investigation.
This chapter reviews the pathophsyiology and pathology of hypertensive arteriopathy of the brain and its relationship to neuroimaging findings, particularly cerebral microbleeds (CMBs). The prevalence of hypertension is highly age dependent. Hypertension-related cerebral diseases include hypertensive encephalopathy, stroke and vascular cognitive impairment. Although the term arteriopathy includes both arteries and arterioles, the chapter focuses on the intrinsic vascular pathology of arterioles in hypertension. Intracranial atherosclerosis of large arteries is more common in hypertension. The presence of hypertensive arteriolosclerosis must be inferred indirectly. Hypertension is a common age-related disease that is accompanied by loss of vascular integrity, with leakage of red blood cells and perivascular hemosiderin deposition. Cerebral microbleeds caused by hypertensive arteriopathy may be seen in the deep hemispheric regions, brainstem, cerebellum and cerebral lobes; however, the pattern of purely lobar CMBs strongly suggests cerebral amyloid angiopathy (CAA) rather than hypertensive arteriopathy.
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.
This chapter focuses on the neurodevelopmental basis of diagnostic overlap and symptom commonality by addressing similarities and differences in the neuroanatomical and functional neurochemical basis of three common childhood/adolescent-onset neuropsychiatric disorders: attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and mood disorder, including major depressive disorder (MDD) and bipolar disorder (BPD). These disorders are selected because of the clinical commonalities with schizophrenia and because of the known or presumed developmental origins of these disorders. Schizophrenia, BPD, and OCD have their onset in adolescence or early adulthood, and they may be preceded by symptoms similar to those in developmental disorders such as ADHD. The disorders are discussed in comparison with schizophrenia. The chapter describes the relevant findings in schizophrenia. It limits the pathophysiological discussion to the neuroimaging findings, and considers common genetic and environmental etiologic factors that may cut across these disorders.
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