MRI Types of Cerebral Small Vessel Disease and Circulating Markers of Vascular Wall Damage

Abstract

The evaluation of the clustering of magnetic resonance imaging (MRI) signs into MRI types and their relationship with circulating markers of vascular wall damage were performed in 96 patients with cerebral small vessel disease (cSVD) (31 men and 65 women; mean age, 60.91 ± 6.57 years). The serum concentrations of the tumor necrosis factor-α (TNF-α), transforming growth factor-β1 (TGF-β1), vascular endothelial growth factor-A (VEGF-A), and hypoxia-inducible factor 1-α (HIF-1α) were investigated in 70 patients with Fazekas stages 2 and 3 of white matter hyperintensities (WMH) and 21 age- and sex-matched volunteers with normal brain MRI using ELISA. The cluster analysis excluded two patients from the further analysis due to restrictions in their scanning protocol. MRI signs of 94 patients were distributed into two clusters. In the first group there were 18 patients with Fazekas 3 stage WMH. The second group consisted of 76 patients with WMH of different stages. The uneven distribution of patients between clusters limited the subsequent steps of statistical analysis; therefore, a cluster comparison was performed in patients with Fazekas stage 3 WMH, designated as MRI type 1 and type 2 of Fazekas 3 stage. There were no differences in age, sex, degree of hypertension, or other risk factors. MRI type 1 had significantly more widespread WMH, lacunes in many areas, microbleeds, atrophy, severe cognitive and gait impairments, and was associated with downregulation of VEGF-A compared with MRI type 2. MRI type 2 had more severe deep WMH, lacunes in the white matter, no microbleeds or atrophy, and less severe clinical manifestations and was associated with upregulation of TNF-α compared with MRI type 1. The established differences reflect the pathogenetic heterogeneity of cSVD and explain the variations in the clinical manifestations observed in Fazekas stage 3 of this disease.

Gait in cerebral small vessel disease, pre-dementia, and dementia: A systematic review

“…A recent example of this approach employed cluster analyses to identify different neuroimaging profiles in individuals with severe CSVD. 9 One cluster displayed widespread periventricular WMH, multiple lacunes and microbleeds, atrophy, severe cognitive and gait abnormalities, and down-regulation of vascular endothelial growth factor-A (indicative of widespread vascular wall damage). The other cluster displayed deep WMH, white matter lacunes, and enlarged perivascular spaces, but relatively less microbleeds and atrophy, less severe cognitive and gait abnormalities, and upregulation of tumor necrosis factor alpha (indicative of systemic inflammation).…”

Associations Between CSF Markers of Inflammation, White Matter Lesions, and Cognitive Decline in Individuals Without Dementia

“…This was a surprising finding because we expected that higher biomarker levels would be associated with more WML over time. Dobrynina et al 43 described lower VEGF-A levels at baseline being associated with more WML in a group of patients with increased prevalence of periventricular WML and more atrophy in general. One possibility is that there are associations between widespread vascular wall damage destroying endothelial cells and lower growth factor production.…”

“…One possibility is that there are associations between widespread vascular wall damage destroying endothelial cells and lower growth factor production. 43 , 44 This could then be followed by a decline in cerebrovascular angiogenesis resulting in hypoxia-induced capillary loss and more WML. 45 In a postmortem analysis, decreased concentrations of several cytokines including IL-16, IL-8, and IL-6 in the frontal white matter across different dementia groups compared with those in controls without dementia were described.…”

Cerebral Small Vessel Disease – A Longitudinal 10 Years Evidenced Study

“…Having been infected with SARS Covid -19, she has recovered with bilateral hypertonicity (could be cerebral hypoxia) but with good functional recovery. She was complaining of a stiff neck, shoulders which were treated with physiotherapy [36][37][38].…”