Cerebral Small Vessel Disease. Might You Have It?
August 10, 2020
Cerebral small vessel disease. You may know it by one of a handful of terms: white matter disease, small vessel ischemic disease, lacunar infarcts, white matter hyperintensities, or Leukoaraiosis. Cerebral small vessel disease (CSVD) encompasses a group of changes and developments (abnormalities) in the small blood vessels of the brain. Today I want to talk about the signs of cerebral small vessel disease and some promising life choices we can make to keep our brains healthy.
Recent reporting by Leslie Kernisan, MD, MPH,* and research done by Dr. Vincent Mok for the Journal of Stroke both note seeing white matter changes, (historically, and still today, called “white matter changes”) when viewing brain tissue on an MRI. Dr. Mok writes, “Lacunar infarcts (small strokes), white matter hyperintensities (these are seen during an MRI), and cerebral microbleeds [meaning bleeding in the brain from a very small blood vessel] are considered various manifestations of cerebral small vessel disease. These lesions are associated with a plethora of disabilities (e.g., stroke, cognitive impairment, depression, gait disturbances, urinary symptoms).”
What Causes Cerebral Small Vessel Disease?
What causes CSVD to develop? That source of all disease: chronically high inflammation. After existing in our bodies for years, and accelerating the development of sticky plaque in our blood vessels and heart, inflammation leads to deposits of plaque, like tiny time bombs, in our brains. The damage accumulates and the small vessels in our brains become blocked – just like in a major artery. These blocks deprive our brain of nourishing blood to keep it humming in perfect tune. Blockages may allow the small vessels to leak blood into our brain tissue, resulting in a brain hemorrhage. Other conditions can also produce white matter changes, but CSVD tops the list of probable causes.
What are the Key Symptoms of CSVD?
We classify CSVD into three levels:
- no noticeable symptoms;
- moderate symptoms; or
- severe symptoms.
Many older adults with CVSD have no noticeable symptoms. Those we notice in folks with moderate to severe CSVD include:
- Cognitive Impairment: When tested, those seniors with CVSD scored worse on the M-MSE, a standard exam given to test cognitive function. Vascular cognitive impairment is the term you might hear in relation to cognitive impairment and cerebral small vessel disease.
- Walking or Balance Issues. Research shows a direct link between increased problems with overall mobility – including standing still and keeping our balance, and a disturbance in our walking and carriage when white matter lesions exist in our brains. Those of us with moderate to severe CVSD experience a noticeable downshift in our walking and balancing abilities.
- Stroke Risk Increase. A study analyzing many studies found a 50% increase in the risk of having a stroke when white matter hyperintensities were present in the brain.