Microangiopathy of the brain: symptoms, causes and treatment

In order for our brain to stay alive and function properly, it needs a constant supply of oxygen and nutrients (especially glucose), which we get through breathing and food. The two elements reach the brain thanks to the irrigation carried out by the vascular system.

However, sometimes injury and damage can cause blood vessels to stop functioning or rupture. One of the disorders that causes it is cerebral microangiopathy.

    Cerebral microangiopathy: concept and typical symptoms

    Cerebral microangiopathy is understood to mean any disorder characterized by the presence of lesions or alterations in the part of the vascular system which supplies the brain. More specifically, it refers to the small blood vessels, arterioles and venules, which are ultimately the closest and are in contact with the target areas.

    In this type of disorder the walls of these blood vessels can become brittle and breakEasily resulting in brain hemorrhages which can cause a variety of symptoms depending on the area where they occur.

    The most typical symptoms of these disorders, which arise from the time the stroke occurs, include paralysis of a part of the body, slurred speech, the presence of continuous headaches, dizziness and vomiting. , loss of consciousness and slowing of speech and movement. Seizures and convulsions, sensory loss, mood swings, and even hallucinations and delusions can occur.

    Microangiopathy of the brain it is not fatal in itself, but the blows it facilitates are very dangerous and can lead to the development of cardiovascular dementias, disability and even death of the patient. Symptoms usually do not appear until the age of 45, with the majority of strokes occurring at older ages. However, there are cases when they happened even in childhood.

    Types of cerebral microangiopathy

    The term cerebral microangiopathy does not refer to a disease in itself, but refers to the set of disorders that cause an altered condition of small blood vessels.

    Thus, within the brain, microangiopathies can find several syndromes and disorders, three of which we present below.

    1. Autosomal dominant cerebral arterial disease with subcortical infarction and leukoencephalopathy (CADASIL).

    Better known by its acronym, CADASIL, this disease of genetic origin mainly affects the arterioles that connect to the subcortical nuclei of the brain, especially in the basal ganglia and around the ventricles.

    The muscles in the walls of these blood vessels gradually degenerate, losing their elasticity and breaking easily. It is an autosomal dominant inherited disease caused by mutations in the NOTCH3 gene.

      2.Cerebroretinal microangiopathy with cysts and calcifications

      Uncommon disease that causes various types of changes in the connections between the visual organs and the brain, In addition to easing bleeding problems in the digestive tract. The main features of this disorder are the presence of cysts and calcifications in the thalamus, basal nuclei and other subcortical regions in both hemispheres. The first symptoms usually appear in childhood, progressing rapidly. Its origin is in the mutations of the CTC1 gene on chromosome 17.

      3. Susac syndrome

      Another disorder caused by microangiopathy is Susac syndrome. It is generated by a non-inflammatory microangiopathy, the main effects of which occur in the brain, retina and hearing, affecting the blood vessels that connect between these areas. This usually results in hearing and visual loss. It is suspected that its origin can be found in autoimmune causes, Although its exact etiology is still unknown.

      the causes

      The specific causes of each microangiopathy will depend on the type of disease or disorder that occurs.

      In many cases, as with CADASIL, the causes of this disorder are genetic, with mutations in genes such as NOTCH3 or COL4A1. However, they can also arise and / or be favored by acquired factors. Indeed, diabetes, obesity, hypercholesterolemia and arterial hypertension influence an important role both in its development and in the worsening of the prognosis of cerebral microangiopathy, assuming relevant risk factors and in taking into account when to explain some of these disorders and in some cases being their direct cause. Some 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 stroke, which contributes an exaggerated amount of this substance to the facilitation of thrombi.

      treatment

      As with the causes and even the symptoms, the specific treatment to apply will depend on the damaged areas. In general, microangiopathies usually do not have a treatment that reverses the problem. however, prevention is essential both in the case of a disorder or problem which facilitates the weakening of the blood vessels (especially in cases which suffer from hypertension, obesity and / or diabetes). This is why it is recommended to establish a healthy lifestyle.

      In addition, different therapeutic strategies can be applied to alleviate symptoms and keep blood vessels stronger. It has been shown that continued application of corticosteroids may improve patient condition. Other substances also improve symptoms, such as. Rehabilitation after an ischemic attack and psychoeducation of the affected person and their environment are other key factors to consider.

      Bibliographical references:

      • Aicardi J. (3rd edition) (2009). Diseases of the nervous system in childhood. London: Mac Keith Press.
      • Kohlschüter A, Bley A, Brockmann K et al. (2010). Leukodystrophies and other metabolic genetic leukoencephalopathies in children and adults. Brain Dev. 32: 82-9.
      • Herrera, DA; Vargas, SA and Montoya, C. (2014). Find by neuroimaginology of retinal cerebral microangiopathy with calcifications and cysts. Biomedical Journal. Vol.34, 2. National Institute of Health. Colombia.
      • Magariños, MM; Corredera, E .; Orizaola, P, Maciñeiras, JL (2004) Susac Syndrome. Differential diagnosis. Med.Clin .; 123: 558-9.
      • Madrid, C .; Arias, M .; Garcia, JC; Cortés, JJ; Lopez, CI; Gonzalez-Spinola, J .; De Sant Joan, A. (2014). CADASIL disease: first results and evolution of lesions on CT and MRI. SERAM.

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