Cerebral Microangiopathy: Symptoms, Causes And Treatment
For our brain to stay alive and function properly, it needs a constant supply of oxygen and nutrients (especially glucose), which we obtain through breathing and eating. Both elements reach the brain through irrigation carried out by the vascular system.
However, sometimes injuries and damage occur that cause blood vessels to stop working properly or break. One of the disorders that causes this is cerebral microangiopathy.
Cerebral microangiopathy: Concept and typical symptoms
Cerebral microangiopathy is understood as any disorder characterized by the presence of lesions or alterations in the part of the vascular system that irrigates the brain. Specifically, reference is made to small blood vessels, arterioles and venules, which are ultimately the closest and are in contact with the target areas.
In this type of disorders the walls of these blood vessels can become brittle and break easily producing brain hemorrhages that can cause a wide variety of symptoms depending on the area where they occur.
The most typical symptoms of these disorders, which derive from the moment in which strokes occur, include paralysis of part of the body, speech alteration, the presence of continuous headaches, dizziness and vomiting, loss of consciousness and slowing of speech and of the movement. Seizures and convulsions, sensory losses, mood disturbances, and even hallucinations and delusions may occur.
Cerebral microangiopathy It is not fatal in itself, but the cerebral infarctions it causes are very dangerous. and can lead to the arrival of cardiovascular dementia, incapacity and even the death of the patient. Symptoms generally do not occur before the age of forty-five, with the majority of brain accidents occurring at older ages. However, there are cases in which they have occurred even in childhood.
Types of cerebral microangiopathy
The term cerebral microangiopathy does not designate a disease itself, but rather refers to the set of disorders that cause an altered state of the small blood vessels.
Thus, within cerebral microangiopathies, various syndromes and disorders can be found, three of which we present below.
1. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL).
Better known by its acronym, CADASIL, this disease of genetic origin especially affects the arterioles that connect with the subcortical nuclei of the brain, especially in the basal ganglia and around the ventricles.
The muscles of the walls of these blood vessels progressively degenerate, losing elasticity and breaking easily. It is an autosomal dominant inherited disorder, caused by mutations in the NOTCH3 gene.
2. Cerebroretinal microangiopathy with cysts and calcifications
Rare disease that causes various types of alterations in the connections between the visual organs and the brain in addition to facilitating bleeding problems in the digestive tract. The main characteristics of this disorder is the presence of cysts and calcifications in the thalami, basal nuclei and other subcortical regions in both hemispheres. The first symptoms usually occur during childhood, evolving rapidly. Its origin is found in mutations of the CTC1 gene on chromosome 17.
Another disorder caused by microangiopathy is Susac syndrome. It is generated by a non-inflammatory microangiopathy whose main effects occur at the brain, retina and auditory level, affecting the blood vessels that connect between these areas. It usually causes hearing and vision loss. It is suspected that its origin may be found in autoimmune causes. although its exact etiology is still unknown.
Causes
The specific causes of each microangiopathy will depend on the type of disease or disorder that occurs.
In many cases, as is the case with CADASIL, the causes of this disorder are of genetic origin, mutations occurring in genes such as NOTCH3 or COL4A1. However, they can also be produced and/or favored by acquired factors. In fact, diabetes, obesity, high cholesterol and high blood pressure play an important role both in developing it and in aggravating the prognosis of cerebral microangiopathy, assuming relevant risk factors that must be taken into account when explaining some of these. disorders and in some cases being their direct cause. Certain infections can also alter and damage blood vessels.
It has also been documented the presence of a high amount of lipoprotein A in many cases of vascular accident, an exaggerated amount of this substance contributing to the facilitation of thrombi.
Treatment
As with the causes and even the symptoms, the specific treatment to be applied will depend on which areas are damaged. In general, microangiopathies do not usually have a treatment that reverses the problem. However, prevention is essential both in the case of having a disorder or problem that facilitates the weakening of blood vessels (especially it is necessary to monitor in those cases that suffer from hypertension, obesity and/or diabetes). That is why it is recommended to establish healthy lifestyle habits.
Apart from this, different therapeutic strategies can be applied to alleviate the symptoms and keep the blood vessels stronger. It has been shown that The continuous application of corticosteroids can improve the condition of patients. Other substances can also improve symptoms, such as: Rehabilitation after an ischemic accident and psychoeducation of the affected person and their environment are other fundamental factors to take into account.
Madrid, C.; Arias, M.; Garcia, JC; Cortes, JJ; López, CI; Gonzalez-Spinola, J.; De San Juan, A. (2014). CADASIL disease: initial findings and evolution of the lesions on CT and MRI. SERAM.
