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Zou K, Deng Q, Zhang H, Huang C. Glymphatic system: a gateway for neuroinflammation. Neural Regen Res 2024; 19:2661-2672. [PMID: 38595285 PMCID: PMC11168510 DOI: 10.4103/1673-5374.391312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/15/2023] [Accepted: 11/09/2023] [Indexed: 04/11/2024] Open
Abstract
The glymphatic system is a relatively recently identified fluid exchange and transport system in the brain. Accumulating evidence indicates that glymphatic function is impaired not only in central nervous system disorders but also in systemic diseases. Systemic diseases can trigger the inflammatory responses in the central nervous system, occasionally leading to sustained inflammation and functional disturbance of the central nervous system. This review summarizes the current knowledge on the association between glymphatic dysfunction and central nervous system inflammation. In addition, we discuss the hypothesis that disease conditions initially associated with peripheral inflammation overwhelm the performance of the glymphatic system, thereby triggering central nervous system dysfunction, chronic neuroinflammation, and neurodegeneration. Future research investigating the role of the glymphatic system in neuroinflammation may offer innovative therapeutic approaches for central nervous system disorders.
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Affiliation(s)
- Kailu Zou
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Qingwei Deng
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Hong Zhang
- Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Changsheng Huang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
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2
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Winfree RL, Erreger K, Phillips J, Seto M, Wang Y, Schneider JA, Bennett DA, Schrag MS, Hohman TJ, Hamm HE. Elevated protease-activated receptor 4 (PAR4) gene expression in Alzheimer's disease predicts cognitive decline. Neurobiol Aging 2024; 140:93-101. [PMID: 38761538 DOI: 10.1016/j.neurobiolaging.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 05/20/2024]
Abstract
Platelet activation of protease-activated receptor 4 (PAR4) and thrombin are at the top of a chain of events leading to fibrin deposition, microinfarcts, blood-brain barrier disruption, and inflammation. We evaluated mRNA expression of the PAR4 gene F2RL3 in human brain and global cognitive performance in participants with and without cognitive impairment or dementia. Data were acquired from the Religious Orders Study (ROS) and the Rush Memory and Aging Project (MAP). F2RL3 mRNA was elevated in AD cases and was associated with worse retrospective longitudinal cognitive performance. Moreover, F2RL3 expression interacted with clinical AD diagnosis on longitudinal cognition whereas this relationship was attenuated in individuals without cognitive impairment. Additionally, when adjusting for the effects of AD neuropathology, F2RL3 expression remained a significant predictor of cognitive decline. F2RL3 expression correlated positively with transcript levels of proinflammatory markers including TNFα, IL-1β, NFκB, and fibrinogen α/β/γ. Together, these results reveal that F2RL3 mRNA expression is associated with multiple AD-relevant outcomes and its encoded product, PAR4, may play a role in disease pathogenesis.
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Affiliation(s)
- Rebecca L Winfree
- Vanderbilt Memory and Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kevin Erreger
- Department of Pharmacology, Vanderbilt University, Nashville, TN, USA
| | - Jared Phillips
- Vanderbilt Memory and Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pharmacology, Vanderbilt University, Nashville, TN, USA
| | - Mabel Seto
- Vanderbilt Memory and Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yanling Wang
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Julie A Schneider
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA; Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Matthew S Schrag
- Vanderbilt Memory and Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Timothy J Hohman
- Vanderbilt Memory and Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pharmacology, Vanderbilt University, Nashville, TN, USA.
| | - Heidi E Hamm
- Vanderbilt Memory and Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pharmacology, Vanderbilt University, Nashville, TN, USA.
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Han B, Zhao Y, Ma L, Chen L, Hou W, Li B, Wang J, Yu J, Wang G, He Y, Ma M, Zhou J, Sun SK, Yu C, Pan J. A Minimalist Iron Oxide Nanoprobe for the High-Resolution Depiction of Stroke by Susceptibility-Weighted Imaging. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024:e2401061. [PMID: 38963320 DOI: 10.1002/smll.202401061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/30/2024] [Indexed: 07/05/2024]
Abstract
The precise mapping of collateral circulation and ischemic penumbra is crucial for diagnosing and treating acute ischemic stroke (AIS). Unfortunately, there exists a significant shortage of high-sensitivity and high-resolution in vivo imaging techniques to fulfill this requirement. Herein, a contrast enhanced susceptibility-weighted imaging (CE-SWI) using the minimalist dextran-modified Fe3O4 nanoparticles (Fe3O4@Dextran NPs) are introduced for the highly sensitive and high-resolution AIS depiction under 9.4 T for the first time. The Fe3O4@Dextran NPs are synthesized via a simple one-pot coprecipitation method using commercial reagents under room temperature. It shows merits of small size (hydrodynamic size 25.8 nm), good solubility, high transverse relaxivity (r2) of 51.3 mM-1s-1 at 9.4 T, and superior biocompatibility. The Fe3O4@Dextran NPs-enhanced SWI can highlight the cerebral vessels readily with significantly improved contrast and ultrahigh resolution of 0.1 mm under 9.4 T MR scanner, enabling the clear spatial identification of collateral circulation in the middle cerebral artery occlusion (MCAO) rat model. Furthermore, Fe3O4@Dextran NPs-enhanced SWI facilitates the precise depiction of ischemia core, collaterals, and ischemic penumbra post AIS through matching analysis with other multimodal MR sequences. The proposed Fe3O4@Dextran NPs-enhanced SWI offers a high-sensitivity and high-resolution imaging tool for individualized characterization and personally precise theranostics of stroke patients.
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Affiliation(s)
- Bing Han
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Yujie Zhao
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Li Ma
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Li Chen
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Wenjing Hou
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Key Laboratory of Digestive Cancer, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Bingjie Li
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Jiaojiao Wang
- Department of Radiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Jiaojiao Yu
- School of Medical Imaging, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University, Tianjin, 300203, China
| | - Guohe Wang
- School of Medical Imaging, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University, Tianjin, 300203, China
| | - Yujing He
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Min Ma
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Junzi Zhou
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Shao-Kai Sun
- School of Medical Imaging, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University, Tianjin, 300203, China
| | - Chunshui Yu
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Jinbin Pan
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
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Schiavolin S, Camarda G, Mazzucchelli A, Mariniello A, Marinoni G, Storti B, Canavero I, Bersano A, Leonardi M. Cognitive and psychological characteristics in patients with Cerebral Amyloid Angiopathy: a literature review. Neurol Sci 2024; 45:3031-3049. [PMID: 38388894 DOI: 10.1007/s10072-024-07399-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
AIM To review the current data on cognitive and psychological characteristics of patients with CAA and on the instruments used for their evaluation. METHODS A systematic search was performed in Embase, Scopus and PubMed with terms related to "cerebral amyloid angiopathy", "neuropsychological measures" and "patient-reported outcome measures" from January 2001 to December 2021. RESULTS Out of 2851 records, 18 articles were selected. The cognitive evaluation was present in all of which, while the psychological one only in five articles. The MMSE (Mini Mental State Examination), TMT (Trail Making Test), fluency test, verbal learning test, digit span, digit symbol and Rey figure tests were the most used cognitive tests, while executive function, memory, processing speed, visuospatial function, attention and language were the most frequent impaired cognitive functions. Depression was the most considered psychological factor usually measured with BDI (Beck Depression Inventory) and GDS (Geriatric Depression Scale). CONCLUSIONS The results of this study might be used in clinical practice as a guide to choose cognitive and psychological instruments and integrate them in the clinical evaluation. The results might also be used in the research field for studies investigating the impact of cognitive and psychological variables on the disease course and for consensus studies aimed at define a standardized evaluation of these aspects.
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Affiliation(s)
- Silvia Schiavolin
- SC Neurologia, Salute Pubblica E Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - Giorgia Camarda
- SC Neurologia, Salute Pubblica E Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy.
| | - Alessia Mazzucchelli
- SC Neurologia, Salute Pubblica E Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - Arianna Mariniello
- SC Neurologia, Salute Pubblica E Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - Giulia Marinoni
- SC Malattie Cerebrovascolari, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Benedetta Storti
- SC Malattie Cerebrovascolari, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Isabella Canavero
- SC Malattie Cerebrovascolari, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Anna Bersano
- SC Malattie Cerebrovascolari, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Matilde Leonardi
- SC Neurologia, Salute Pubblica E Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
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Zhang D, Ma H, Liu C, Li Y. Relationship between morning blood pressure variability and cerebral microbleed burden in patients with hypertension. J Clin Hypertens (Greenwich) 2024; 26:665-673. [PMID: 38775194 PMCID: PMC11180696 DOI: 10.1111/jch.14831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 03/26/2024] [Accepted: 04/26/2024] [Indexed: 06/18/2024]
Abstract
Cerebral microbleeds (CMBs) can be understood as a type of target organ damage caused by hypertension. We aimed to explore the association of the CMB burden with morning blood pressure (BP) variability in patients with hypertension. We divided patients with hypertension into two groups: a group with 1-10 CMBs and a group with more than 10 CMBs. The duration, grade, medication, and control of hypertension were recorded in all patients. Morning home BP measurements were performed every 3 days for a month. A total of 791 patients were recruited. Full factor model analysis showed that higher morning home diastolic BP variability (standard deviation [SD], OR = 1.080, 95% CI: 1.024-1.140, P = .005; coefficient of variation [CV], OR = 1.076, 95% CI: 1.028-1.128, P = .002) was associated with more than 10 CMBs. Morning home systolic and diastolic blood pressure variability (SD, CV, average real variability) in more than 10 non-lobar CMBs group was significantly higher than that in 1-10 non-lobar CMBs group (P < .05).The multivariate analysis showed higher morning home diastolic blood pressure variability (SD, OR = 1.124, 95% CI: 1.031-1.224, P = .008; CV, OR = 1.099, 95% CI: 1.019-1.186, P = .015; average real variability, OR = 1.055, 95% CI: 0.995-1.120, P = .075) was associated with more than 10 non-lobar CMBs. There was no significant relationship between morning home systolic blood pressure variability and more than 10 non-lobar CMBs (P > .05). Higher morning home diastolic blood pressure variability was associated with more than 10 CMBs and more than 10 non-lobar CMBs.
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Affiliation(s)
- Dongsen Zhang
- Department of NeurologyTangshan GongRen HospitalTangshanChina
| | - Hongying Ma
- Department of NeurologyTangshan GongRen HospitalTangshanChina
| | - Chunqin Liu
- Department of NeurologyTangshan GongRen HospitalTangshanChina
| | - Yongqiu Li
- Department of NeurologyTangshan GongRen HospitalTangshanChina
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Xu M, Zhu Y, Song X, Zhong X, Yu X, Wang D, Cheng Y, Tao W, Wu B, Liu M. Pathological Changes of Small Vessel Disease in Intracerebral Hemorrhage: a Systematic Review and Meta-analysis. Transl Stroke Res 2024; 15:533-544. [PMID: 37280502 PMCID: PMC11106194 DOI: 10.1007/s12975-023-01154-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 06/08/2023]
Abstract
In intracerebral hemorrhage (ICH) with pathology-proven etiology, we performed a systematic review and meta-analysis to elucidate the association between cerebral amyloid angiopathy (CAA) and arteriolosclerosis, and directly compared MRI and pathological changes of markers of cerebral small vessel disease (CSVD). Studies enrolling primary ICH who had received an etiological diagnosis through biopsy or autopsy were searched using Ovid MEDLINE, PubMed, and Web of Science from inception to June 8, 2022. We extracted pathological changes of CSVD for each patient whenever available. Patients were grouped into CAA + arteriolosclerosis, strict CAA, and strict arteriolosclerosis subgroups. Of 4155 studies identified, 28 studies with 456 ICH patients were included. The frequency of lobar ICH (p<0.001) and total microbleed number (p=0.015) differed among patients with CAA + arteriolosclerosis, strict CAA, and strict arteriolosclerosis. Concerning pathology, severe CAA was associated with arteriolosclerosis (OR 6.067, 95% CI 1.107-33.238, p=0.038), although this association was not statistically significant after adjusting for age and sex. Additionally, the total microbleed number (median 15 vs. 0, p=0.006) was higher in ICH patients with CAA evidence than those without CAA. The pathology of CSVD imaging markers was mostly investigated in CAA-ICH. There was inconsistency concerning CAA severity surrounding microbleeds. Small diffusion-weighted imaging lesions could be matched to acute microinfarct histopathologically. Studies that directly correlated MRI and pathology of lacunes, enlarged perivascular spaces, and atrophy were scarce. Arteriolosclerosis might be associated with severe CAA. The pathological changes of CSVD markers by ICH etiology are needed to be investigated further.
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Affiliation(s)
- Mangmang Xu
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
- Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Sichuan Province, Chengdu, China
| | - Yuyi Zhu
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
- Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Sichuan Province, Chengdu, China
| | - Xindi Song
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
- Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Sichuan Province, Chengdu, China
| | - Xuelian Zhong
- West China School of Nursing, Sichuan University/West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Xinxin Yu
- Department of Orthodontics, ChengDu Dental Hospital, Chengdu, Sichuan Province, China
| | - Deren Wang
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
- Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Sichuan Province, Chengdu, China
| | - Yajun Cheng
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
- Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Sichuan Province, Chengdu, China
| | - Wendan Tao
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
- Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Sichuan Province, Chengdu, China
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China.
- Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Sichuan Province, Chengdu, China.
| | - Ming Liu
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China.
- Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Sichuan Province, Chengdu, China.
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Ventura-Antunes L, Nackenoff A, Romero-Fernandez W, Bosworth AM, Prusky A, Wang E, Carvajal-Tapia C, Shostak A, Harmsen H, Mobley B, Maldonado J, Solopova E, Caleb Snider J, David Merryman W, Lippmann ES, Schrag M. Arteriolar degeneration and stiffness in cerebral amyloid angiopathy are linked to β-amyloid deposition and lysyl oxidase. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.08.583563. [PMID: 38659767 PMCID: PMC11042178 DOI: 10.1101/2024.03.08.583563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Cerebral amyloid angiopathy (CAA) is a vasculopathy characterized by vascular β-amyloid (Aβ) deposition on cerebral blood vessels. CAA is closely linked to Alzheimer's disease (AD) and intracerebral hemorrhage. CAA is associated with the loss of autoregulation in the brain, vascular rupture, and cognitive decline. To assess morphological and molecular changes associated with the degeneration of penetrating arterioles in CAA, we analyzed post-mortem human brain tissue from 26 patients with mild, moderate, and severe CAA end neurological controls. The tissue was optically cleared for three-dimensional light sheet microscopy, and morphological features were quantified using surface volume rendering. We stained Aβ, vascular smooth muscle (VSM), lysyl oxidase (LOX), and vascular markers to visualize the relationship between degenerative morphological features, including vascular dilation, dolichoectasia (variability in lumenal diameter) and tortuosity, and the volumes of VSM, Aβ, and LOX in arterioles. Atomic force microscopy (AFM) was used to assess arteriolar wall stiffness, and we identified a pattern of morphological features associated with degenerating arterioles in the cortex. The volume of VSM associated with the arteriole was reduced by around 80% in arterioles with severe CAA and around 60% in cases with mild/moderate CAA. This loss of VSM correlated with increased arteriolar diameter and variability of diameter, suggesting VSM loss contributes to arteriolar laxity. These vascular morphological features correlated strongly with Aβ deposits. At sites of microhemorrhage, Aβ was consistently present, although the morphology of the deposits changed from the typical organized ring shape to sharply contoured shards with marked dilation of the vessel. AFM showed that arteriolar walls with CAA were more than 400% stiffer than those without CAA. Finally, we characterized the association of vascular degeneration with LOX, finding strong associations with VSM loss and vascular degeneration. These results show an association between vascular Aβ deposition, microvascular degeneration, and increased vascular stiffness, likely due to the combined effects of replacement of VSM by β-amyloid, cross-linking of extracellular matrices (ECM) by LOX, and possibly fibrosis. This advanced microscopic imaging study clarifies the association between Aβ deposition and vascular fragility. Restoration of physiologic ECM properties in penetrating arteries may yield a novel therapeutic strategy for CAA.
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Affiliation(s)
| | - Alex Nackenoff
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Allison M Bosworth
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Alex Prusky
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emmeline Wang
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Alena Shostak
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hannah Harmsen
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bret Mobley
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jose Maldonado
- Vanderbilt Neurovisualization Lab, Vanderbilt University, Nashville, TN, USA
| | - Elena Solopova
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J. Caleb Snider
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - W. David Merryman
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Ethan S Lippmann
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville TN, USA
- Department of Chemical and Biomolecular Engineering, Vanderbilt University, Nashville, TN, USA
| | - Matthew Schrag
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville TN, USA
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University Medical Center, Nashville, TN, USA
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8
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Nadareishvili Z, Katsanos AH, Shoamanesh A. Efficacy and Safety of Statins for Secondary Stroke Prevention in Patients With Cerebral Microbleeds: Jury Is Still Out. Neurology 2024; 102:e209261. [PMID: 38471050 DOI: 10.1212/wnl.0000000000209261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/09/2024] [Indexed: 03/14/2024] Open
Affiliation(s)
- Zurab Nadareishvili
- From the Department of Neurology and Rehabilitation Medicine (Z.N.), The George Washington University School of Medicine and Health Sciences, Washington, DC, and Comprehensive Stroke Center, VHC Health, Arlington, VA; and Department of Medicine-Neurology (A.H.K., A.S.), McMaster University / Population Health Research Institute, Hamilton, ON, Canada
| | - Aristeidis H Katsanos
- From the Department of Neurology and Rehabilitation Medicine (Z.N.), The George Washington University School of Medicine and Health Sciences, Washington, DC, and Comprehensive Stroke Center, VHC Health, Arlington, VA; and Department of Medicine-Neurology (A.H.K., A.S.), McMaster University / Population Health Research Institute, Hamilton, ON, Canada
| | - Ashkan Shoamanesh
- From the Department of Neurology and Rehabilitation Medicine (Z.N.), The George Washington University School of Medicine and Health Sciences, Washington, DC, and Comprehensive Stroke Center, VHC Health, Arlington, VA; and Department of Medicine-Neurology (A.H.K., A.S.), McMaster University / Population Health Research Institute, Hamilton, ON, Canada
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9
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Solopova E, Romero-Fernandez W, Harmsen H, Ventura-Antunes L, Wang E, Shostak A, Maldonado J, Donahue MJ, Schultz D, Coyne TM, Charidimou A, Schrag M. Fatal iatrogenic cerebral β-amyloid-related arteritis in a woman treated with lecanemab for Alzheimer's disease. Nat Commun 2023; 14:8220. [PMID: 38086820 PMCID: PMC10716177 DOI: 10.1038/s41467-023-43933-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
We report the case of a 79-year-old woman with Alzheimer's disease who participated in a Phase III randomized controlled trial called CLARITY-AD testing the experimental drug lecanemab. She was randomized to the placebo group and subsequently enrolled in an open-label extension which guaranteed she received the active drug. After the third biweekly infusion, she suffered a seizure characterized by speech arrest and a generalized convulsion. Magnetic resonance imaging revealed she had multifocal swelling and a marked increase in the number of cerebral microhemorrhages. She was treated with an antiepileptic regimen and high-dose intravenous corticosteroids but continued to worsen and died after 5 days. Post-mortem MRI confirmed extensive microhemorrhages in the temporal, parietal and occipital lobes. The autopsy confirmed the presence of two copies of APOE4, a gene associated with a higher risk of Alzheimer's disease, and neuropathological features of moderate severity Alzheimer's disease and severe cerebral amyloid angiopathy with perivascular lymphocytic infiltrates, reactive macrophages and fibrinoid degeneration of vessel walls. There were deposits of β-amyloid in meningeal vessels and penetrating arterioles with numerous microaneurysms. We conclude that the patient likely died as a result of severe cerebral amyloid-related inflammation.
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Affiliation(s)
- Elena Solopova
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Hannah Harmsen
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Emmeline Wang
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alena Shostak
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jose Maldonado
- Vanderbilt Neurovisualization Lab, Vanderbilt University, Nashville, TN, USA
| | - Manus J Donahue
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Daniel Schultz
- Final Diagnosis: Private Autopsy Florida - Forensic Pathology Lab, Tampa, FL, USA
| | - Thomas M Coyne
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, USA
| | | | - Matthew Schrag
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
- The Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA.
- Vanderbilt Memory and Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN, USA.
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Yu X, Yin X, Hong H, Wang S, Jiaerken Y, Xu D, Zhang F, Zhang R, Yang L, Zhang B, Zhang M, Huang P. Presumed periventricular venous infarction on magnetic resonance imaging and its association with increased white matter edema in CADASIL. Eur Radiol 2023; 33:8057-8066. [PMID: 37284868 DOI: 10.1007/s00330-023-09744-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Venous pathology could contribute to the development of parenchymal lesions in cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). We aim to identify presumed periventricular venous infarction (PPVI) in CADASIL and analyze the associations between PPVI, white matter edema, and microstructural integrity within white matter hyperintensities (WMHs) regions. METHODS We included forty-nine patients with CADASIL from a prospectively enrolled cohort. PPVI was identified according to previously established MRI criteria. White matter edema was evaluated using the free water (FW) index derived from diffusion tensor imaging (DTI), and microstructural integrity was evaluated using FW-corrected DTI parameters. We compared the mean FW values and regional volumes with different levels of FW (ranging from 0.3 to 0.8) in WMHs regions between the PPVI and non-PPVI groups. We used intracranial volume to normalize each volume. We also analyzed the association between FW and microstructural integrity in fiber tracts connected with PPVI. RESULTS We found 16 PPVIs in 10 of 49 CADASIL patients (20.4%). The PPVI group had larger WMHs volume (0.068 versus 0.046, p = 0.036) and higher FW in WMHs (0.55 versus 0.52, p = 0.032) than the non-PPVI group. Larger areas with high FW content were also found in the PPVI group (threshold: 0.7, 0.47 versus 0.37, p = 0.015; threshold: 0.8, 0.33 versus 0.25, p = 0.003). Furthermore, higher FW correlated with decreased microstructural integrity (p = 0.009) in fiber tracts connected with PPVI. CONCLUSIONS PPVI was associated with increased FW content and white matter degeneration in CADASIL patients. CLINICAL RELEVANCE STATEMENT PPVI is an important factor related with WMHs, and therefore, preventing the occurrence of PPVI would be beneficial for patients with CADASIL. KEY POINTS •Presumed periventricular venous infarction is important and occurs in about 20% of patients with CADASIL. •Presumed periventricular venous infarction was associated with increased free water content in the regions of white matter hyperintensities. •Free water correlated with microstructural degenerations in white matter tracts connected with the presumed periventricular venous infarction.
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Affiliation(s)
- Xinfeng Yu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Xinzhen Yin
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Hong
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Shuyue Wang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Yeerfan Jiaerken
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Duo Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Fan Zhang
- University of Electronic Science and Technology of China, Chengdu, China
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ruiting Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Linglin Yang
- Department of Psychiatry, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Baorong Zhang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China.
| | - Peiyu Huang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China.
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11
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Panigrahy A, Schmithorst V, Ceschin R, Lee V, Beluk N, Wallace J, Wheaton O, Chenevert T, Qiu D, Lee JN, Nencka A, Gagoski B, Berman JI, Yuan W, Macgowan C, Coatsworth J, Fleysher L, Cannistraci C, Sleeper LA, Hoskoppal A, Silversides C, Radhakrishnan R, Markham L, Rhodes JF, Dugan LM, Brown N, Ermis P, Fuller S, Cotts TB, Rodriguez FH, Lindsay I, Beers S, Aizenstein H, Bellinger DC, Newburger JW, Umfleet LG, Cohen S, Zaidi A, Gurvitz M. Design and Harmonization Approach for the Multi-Institutional Neurocognitive Discovery Study (MINDS) of Adult Congenital Heart Disease (ACHD) Neuroimaging Ancillary Study: A Technical Note. J Cardiovasc Dev Dis 2023; 10:381. [PMID: 37754810 PMCID: PMC10532244 DOI: 10.3390/jcdd10090381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/28/2023] Open
Abstract
Dramatic advances in the management of congenital heart disease (CHD) have improved survival to adulthood from less than 10% in the 1960s to over 90% in the current era, such that adult CHD (ACHD) patients now outnumber their pediatric counterparts. ACHD patients demonstrate domain-specific neurocognitive deficits associated with reduced quality of life that include deficits in educational attainment and social interaction. Our hypothesis is that ACHD patients exhibit vascular brain injury and structural/physiological brain alterations that are predictive of specific neurocognitive deficits modified by behavioral and environmental enrichment proxies of cognitive reserve (e.g., level of education and lifestyle/social habits). This technical note describes an ancillary study to the National Heart, Lung, and Blood Institute (NHLBI)-funded Pediatric Heart Network (PHN) "Multi-Institutional Neurocognitive Discovery Study (MINDS) in Adult Congenital Heart Disease (ACHD)". Leveraging clinical, neuropsychological, and biospecimen data from the parent study, our study will provide structural-physiological correlates of neurocognitive outcomes, representing the first multi-center neuroimaging initiative to be performed in ACHD patients. Limitations of the study include recruitment challenges inherent to an ancillary study, implantable cardiac devices, and harmonization of neuroimaging biomarkers. Results from this research will help shape the care of ACHD patients and further our understanding of the interplay between brain injury and cognitive reserve.
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Affiliation(s)
- Ashok Panigrahy
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
- Department of Pediatric Radiology, Children’s Hospital of Pittsburgh of UPMC, 45th Str., Penn Ave., Pittsburgh, PA 15201, USA
| | - Vanessa Schmithorst
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Rafael Ceschin
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Vince Lee
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Nancy Beluk
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Julia Wallace
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Olivia Wheaton
- HealthCore Inc., 480 Pleasant Str., Watertown, MA 02472, USA;
| | - Thomas Chenevert
- Department of Radiology, Michigan Medicine University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI 48109, USA;
- Congenital Heart Center, C. S. Mott Children’s Hospital, 1540 E Hospital Dr., Ann Arbor, MI 48109, USA
| | - Deqiang Qiu
- Department of Radiology and Imaging Sciences, Emory School of Medicine, 1364 Clifton Rd., Atlanta, GA 30322, USA;
| | - James N Lee
- Department of Radiology, The University of Utah, 50 2030 E, Salt Lake City, UT 84112, USA;
| | - Andrew Nencka
- Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave., Milwaukee, WI 53226, USA;
| | - Borjan Gagoski
- Department of Radiology, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA;
| | - Jeffrey I. Berman
- Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA;
| | - Weihong Yuan
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA;
- Department of Radiology, University of Cincinnati College of Medicine, 3230 Eden Ave., Cincinnati, OH 45267, USA
| | - Christopher Macgowan
- Department of Medical Biophysics, University of Toronto, 101 College Str. Suite 15-701, Toronto, ON M5G 1L7, Canada;
- The Hospital for Sick Children Division of Translational Medicine, 555 University Ave., Toronto, ON M5G 1X8, Canada
| | - James Coatsworth
- Department of Radiology, Medical University of South Carolina, 171 Ashley Ave., Room 372, Charleston, SC 29425, USA;
| | - Lazar Fleysher
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave., New York, NY 10029, USA; (L.F.); (C.C.); (A.Z.)
| | - Christopher Cannistraci
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave., New York, NY 10029, USA; (L.F.); (C.C.); (A.Z.)
| | - Lynn A. Sleeper
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA; (L.A.S.); (J.W.N.); (M.G.)
| | - Arvind Hoskoppal
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Candice Silversides
- Department of Cardiology, University of Toronto, C. David Naylor Building, 6 Queen’s Park Crescent West, Third Floor, Toronto, ON M5S 3H2, Canada;
| | - Rupa Radhakrishnan
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 University Blvd., Indianapolis, IN 46202, USA;
| | - Larry Markham
- Department of Cardiology, University of Indiana School of Medicine, 545 Barnhill Dr., Indianapolis, IN 46202, USA;
| | - John F. Rhodes
- Department of Cardiology, Medical University of South Carolina, 96 Jonathan Lucas Str. Ste. 601, MSC 617, Charleston, SC 29425, USA;
| | - Lauryn M. Dugan
- Department of Cardiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA; (L.M.D.); (N.B.)
| | - Nicole Brown
- Department of Cardiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA; (L.M.D.); (N.B.)
| | - Peter Ermis
- Department of Radiology, Texas Children’s Hospital, Houston, TX 77030, USA; (P.E.); (S.F.)
| | - Stephanie Fuller
- Department of Radiology, Texas Children’s Hospital, Houston, TX 77030, USA; (P.E.); (S.F.)
| | - Timothy Brett Cotts
- Departments of Internal Medicine and Pediatrics, Michigan Medicine University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI 48109, USA;
| | - Fred Henry Rodriguez
- Department of Cardiology, Emory School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA;
| | - Ian Lindsay
- Department of Cardiology, The University of Utah, 95 S 2000 E, Salt Lake City, UT 84112, USA;
| | - Sue Beers
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Str., Pittsburgh, PA 15213, USA; (S.B.); (H.A.)
| | - Howard Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Str., Pittsburgh, PA 15213, USA; (S.B.); (H.A.)
| | - David C. Bellinger
- Cardiac Neurodevelopmental Program, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA;
| | - Jane W. Newburger
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA; (L.A.S.); (J.W.N.); (M.G.)
| | - Laura Glass Umfleet
- Department of Neuropsychology, Medical College of Wisconsin, 9200 W Wisconsin Ave., Milwaukee, WI 53226, USA;
| | - Scott Cohen
- Heart and Vascular Center, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA;
| | - Ali Zaidi
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave., New York, NY 10029, USA; (L.F.); (C.C.); (A.Z.)
| | - Michelle Gurvitz
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA; (L.A.S.); (J.W.N.); (M.G.)
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12
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Nikseresht G, Evia AM, Nag S, Leurgans SE, Capuano AW, Agam G, Barnes LL, Bennett DA, Schneider JA, Arfanakis K. Neuropathologic correlates of cerebral microbleeds in community-based older adults. Neurobiol Aging 2023; 129:89-98. [PMID: 37279617 PMCID: PMC10524842 DOI: 10.1016/j.neurobiolaging.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/14/2023] [Accepted: 05/04/2023] [Indexed: 06/08/2023]
Abstract
Cerebral microbleeds (CMBs) appearing as hypointense foci on T2*-weighted magnetic resonance images are small hemorrhages that have been linked to cognitive decline and increased mortality. However, the neuropathologic correlates of CMBs in community-based older adults are poorly understood. The present study investigated the association of age-related neuropathologies with CMBs in community-based older adults. Cerebral hemispheres from 289 participants of the Rush Memory and Aging Project, Religious Orders Study, Minority Aging Research Study, and Rush Alzheimer's Disease Clinical Core underwent ex vivo MRI and detailed neuropathologic examination. Following Bonferroni correction, CMBs in the cerebrum overall and in the frontal lobe were associated with cerebral amyloid angiopathy, CMBs in the frontal lobe were also associated with arteriolosclerosis, and CMBs in the basal ganglia showed a borderline significant association with microinfarcts. These findings suggest that CMBs can aid in the prediction of small vessel disease in community-based older adults. Finally, CMBs were not associated with dementia, suggesting that CMBs in community-based older adults may not be linked to substantial cognitive impairment.
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Affiliation(s)
- Grant Nikseresht
- Department of Computer Science, Illinois Institute of Technology, Chicago, IL, USA; Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA
| | - Arnold M Evia
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Sukriti Nag
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Sue E Leurgans
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Ana W Capuano
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Gady Agam
- Department of Computer Science, Illinois Institute of Technology, Chicago, IL, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Konstantinos Arfanakis
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA; Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Diagnostic Radiology, Rush University Medical Center, Chicago, IL, USA.
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13
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Liu R, Shi X, Feng J, Piao J, Yang Z, Zhao Y, Yin H, Chen X. Ischemic Stroke and Cerebral Microbleeds: A Two-Sample Bidirectional Mendelian Randomization Study. Neurol Ther 2023; 12:1299-1308. [PMID: 37270442 PMCID: PMC10310681 DOI: 10.1007/s40120-023-00500-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/15/2023] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION Recent observational studies have reported the association between ischemic stroke (IS) and cerebral microbleeds (CMBs). Whether this reflects a causal association remains to be established. Herein, we adopted a two-sample bidirectional Mendelian randomization (MR) analysis to comprehensively evaluate the causal association of IS and CMBs. METHODS The summary-level genome-wide association studies (GWASs) data of IS were obtained from the GIGASTROKE consortium (62,100 European ancestry cases and 1,234,808 European ancestry controls). All IS cases could be further divided into large-vessel atherosclerosis stroke (LVS, n = 6399), cardio-embolic stroke (CES, n = 10,804) and small-vessel occlusion stroke (SVS, n = 6811). Meanwhile, we used publicly available summary statistics from published GWASs of CMBs (3556 of the 25,862 European participants across 2 large initiatives). A bidirectional MR analysis was conducted using inverse-variance weighting (IVW) as the major outcome, whereas MR-Egger and weighted median (WM) were used to complement the IVW estimates as they can provide more robust estimates in a broader set of scenarios but are less efficient (wider CIs). A Bonferroni-corrected threshold of p < 0.0125 was considered significant, and p values between 0.0125 and 0.05 were considered suggestive of evidence for a potential association. RESULTS We detected that higher risk of IS [IVW odds ratio (OR) 1.47, 95% confidence interval (CI) 1.04-2.07, p = 0.03] and SVS (IVW OR 1.62, 95% CI 1.07-2.47, p = 0.02) were significantly associated with CMBs. Reverse MR analyses found no significant evidence for a causal effect of CMBs on IS and its subtypes. CONCLUSIONS Our study provides potential evidence that IS and SVS are causally linked to increased risk of CMBs. Further research is needed to determine the mechanisms of association between IS and CMBs.
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Affiliation(s)
- Renjie Liu
- Department of Neurovascular Surgery, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Xin Shi
- Department of Radiology, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Jiahui Feng
- Department of Neurovascular Surgery, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Jianmin Piao
- Department of Neurovascular Surgery, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Zhongxi Yang
- Department of Neurovascular Surgery, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Yuhao Zhao
- Department of Neurovascular Surgery, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Haoyuan Yin
- Department of Neurovascular Surgery, The First Hospital of Jilin University, Changchun, 130021, Jilin, China.
| | - Xuan Chen
- Department of Neurovascular Surgery, The First Hospital of Jilin University, Changchun, 130021, Jilin, China.
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14
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Marshall CR, Farrow MA, Djambazova KV, Spraggins JM. Untangling Alzheimer's disease with spatial multi-omics: a brief review. Front Aging Neurosci 2023; 15:1150512. [PMID: 37533766 PMCID: PMC10390637 DOI: 10.3389/fnagi.2023.1150512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/13/2023] [Indexed: 08/04/2023] Open
Abstract
Alzheimer's disease (AD) is the most common form of neurological dementia, specified by extracellular β-amyloid plaque deposition, neurofibrillary tangles, and cognitive impairment. AD-associated pathologies like cerebral amyloid angiopathy (CAA) are also affiliated with cognitive impairment and have overlapping molecular drivers, including amyloid buildup. Discerning the complexity of these neurological disorders remains a significant challenge, and the spatiomolecular relationships between pathogenic features of AD and AD-associated pathologies remain poorly understood. This review highlights recent developments in spatial omics, including profiling and molecular imaging methods, and how they are applied to AD. These emerging technologies aim to characterize the relationship between how specific cell types and tissue features are organized in combination with mapping molecular distributions to provide a systems biology view of the tissue microenvironment around these neuropathologies. As spatial omics methods achieve greater resolution and improved molecular coverage, they are enabling deeper characterization of the molecular drivers of AD, leading to new possibilities for the prediction, diagnosis, and mitigation of this debilitating disease.
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Affiliation(s)
- Cody R. Marshall
- Chemical and Physical Biology Program, Vanderbilt University School of Medicine, Nashville, TN, United States
- Mass Spectrometry Research Center, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Melissa A. Farrow
- Mass Spectrometry Research Center, Vanderbilt University School of Medicine, Nashville, TN, United States
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Katerina V. Djambazova
- Mass Spectrometry Research Center, Vanderbilt University School of Medicine, Nashville, TN, United States
- Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Jeffrey M. Spraggins
- Chemical and Physical Biology Program, Vanderbilt University School of Medicine, Nashville, TN, United States
- Mass Spectrometry Research Center, Vanderbilt University School of Medicine, Nashville, TN, United States
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, TN, United States
- Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN, United States
- Department of Chemistry, Vanderbilt University, Nashville, TN, United States
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15
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Kelly L, Sharp MM, Thomas I, Brown C, Schrag M, Antunes LV, Solopova E, Martinez-Gonzalez J, Rodríguez C, Carare RO. Targeting lysyl-oxidase (LOX) may facilitate intramural periarterial drainage for the treatment of Alzheimer's disease. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 5:100171. [PMID: 37457664 PMCID: PMC10338210 DOI: 10.1016/j.cccb.2023.100171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/07/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023]
Abstract
Alzheimer's disease is the commonest form of dementia. It is likely that a lack of clearance of amyloid beta (Aβ) results in its accumulation in the parenchyma as Aβ oligomers and insoluble plaques, and within the walls of blood vessels as cerebral amyloid angiopathy (CAA). The drainage of Aβ along the basement membranes of blood vessels as intramural periarterial drainage (IPAD), could be improved if the driving force behind IPAD could be augmented, therefore reducing Aβ accumulation. There are alterations in the composition of the vascular basement membrane in Alzheimer's disease. Lysyl oxidase (LOX) is an enzyme involved in the remodelling of the extracellular matrix and its expression and function is altered in various disease states. The expression of LOX is increased in Alzheimer's disease, but it is unclear whether this is a contributory factor in the impairment of IPAD in Alzheimer's disease. The pharmacological inhibition of LOX may be a strategy to improve IPAD and reduce the accumulation of Aβ in the parenchyma and within the walls of blood vessels.
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Affiliation(s)
- Louise Kelly
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom, UK
| | | | | | - Christopher Brown
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom, UK
| | - Matthew Schrag
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Memory and Alzheimer's Center, Vanderbilt University, Nashville, Tennessee, United States of America
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, Tennessee, USA
| | - Lissa Ventura Antunes
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Memory and Alzheimer's Center, Vanderbilt University, Nashville, Tennessee, United States of America
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, Tennessee, USA
| | - Elena Solopova
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Memory and Alzheimer's Center, Vanderbilt University, Nashville, Tennessee, United States of America
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, Tennessee, USA
| | - José Martinez-Gonzalez
- Instituto de Investigaciones Biomédicas de Barcelona (IIBB-CSIC), Barcelona, Spain
- CIBER de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Cristina Rodríguez
- CIBER de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
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16
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La Rosa C, Donato PD, Specchi S, Bernardini M. Susceptibility artifact morphology is more conspicuous on susceptibility-weighted imaging compared to T2* gradient echo sequences in the brains of dogs and cats with suspected intracranial disease. Vet Radiol Ultrasound 2023; 64:464-472. [PMID: 36633010 DOI: 10.1111/vru.13210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 11/29/2022] [Accepted: 12/12/2022] [Indexed: 01/13/2023] Open
Abstract
Susceptibility-weighted imaging (SWI) has been found to be more reliable in the detection of vessels and blood products than T2*-weighted gradient echo (GE) in several human brain diseases. In veterinary medicine, published information on the diagnostic usefulness of SWI is lacking. The aim of this retrospective observational study was to investigate the value of SWI compared to T2*-weighted GE images in a population of dogs and cats with presumed, MRI-based diagnoses grouped as neoplastic (27), cerebrovascular (14), inflammatory (14), head trauma (5), other pathologies (4), or that were normal (36). Areas of signal void (ASV) were assessed based on shape, distribution, number, and conspicuity. Presence of ASV was found in 31 T2*-weighted GE and 40 SWI sequences; the conspicuity of lesions increased in 92.5% of cases with SWI. A 44.7% increase in the number of cerebral microbleeds (CMBs) was identified within the population using SWI (110) compared to T2*-weighted GE (76). Linear ASV presumed to be abnormal vascular structures, as are reported in humans, were identified in 12 T2*-weighted GE and 19 SWI sequences. In presumed brain tumors, abnormal vascular structures were detected in 11 of 27 (40.7%) cases on T2*-weighted GE and in 16 of 27 (59.3%) cases on SWI, likely representing tumor neovascularization; amorphous ASV interpreted as presumed hemorrhages on T2*-weighted GE were diagnosed as vessels on SWI in five of 27 (18.5%) cases. Since SWI shows ASV more conspicuously than T2*-weighted GE, the authors advocate the use of SWI in veterinary patients.
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Affiliation(s)
- Claudia La Rosa
- Anicura Ospedale Veterinario I Portoni Rossi, Zola Predosa, Italy
| | - Pamela Di Donato
- Anicura Ospedale Veterinario I Portoni Rossi, Zola Predosa, Italy
- Antech Imaging Service, Fountain Valley, California, USA
| | - Swan Specchi
- Anicura Ospedale Veterinario I Portoni Rossi, Zola Predosa, Italy
- Antech Imaging Service, Fountain Valley, California, USA
| | - Marco Bernardini
- Anicura Ospedale Veterinario I Portoni Rossi, Zola Predosa, Italy
- Department of Animal Medicine, Production and Health, University of Padua, Legnaro, Italy
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17
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Magaki S, Chen Z, Severance A, Williams CK, Diaz R, Fang C, Khanlou N, Yong WH, Paganini-Hill A, Kalaria RN, Vinters HV, Fisher M. Neuropathology of microbleeds in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). J Neuropathol Exp Neurol 2023; 82:333-344. [PMID: 36715085 PMCID: PMC10025882 DOI: 10.1093/jnen/nlad004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Cerebral microbleeds (CMBs) detected on magnetic resonance imaging are common in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). The neuropathologic correlates of CMBs are unclear. In this study, we characterized findings relevant to CMBs in autopsy brain tissue of 8 patients with genetically confirmed CADASIL and 10 controls within the age range of the CADASIL patients by assessing the distribution and extent of hemosiderin/iron deposits including perivascular hemosiderin leakage (PVH), capillary hemosiderin deposits, and parenchymal iron deposits (PID) in the frontal cortex and white matter, basal ganglia and cerebellum. We also characterized infarcts, vessel wall thickening, and severity of vascular smooth muscle cell degeneration. CADASIL subjects had a significant increase in hemosiderin/iron deposits compared with controls. This increase was principally seen with PID. Hemosiderin/iron deposits were seen in the majority of CADASIL subjects in all brain areas. PVH was most pronounced in the frontal white matter and basal ganglia around small to medium sized arterioles, with no predilection for the vicinity of vessels with severe vascular changes or infarcts. CADASIL subjects have increased brain hemosiderin/iron deposits but these do not occur in a periarteriolar distribution. Pathogenesis of these lesions remains uncertain.
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Affiliation(s)
- Shino Magaki
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Zesheng Chen
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Alyscia Severance
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Christopher K Williams
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Ramiro Diaz
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Chuo Fang
- Department of Neurology, University of California-Irvine School of Medicine, Irvine, California, USA
| | - Negar Khanlou
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - William H Yong
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Annlia Paganini-Hill
- Department of Neurology, University of California-Irvine School of Medicine, Irvine, California, USA
| | - Rajesh N Kalaria
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Harry V Vinters
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
- Department of Neurology, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
- Brain Research Institute, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Mark Fisher
- Department of Neurology, University of California-Irvine School of Medicine, Irvine, California, USA
- Department of Pathology and Laboratory Medicine, University of California-Irvine School of Medicine, Irvine, California, USA
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18
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Ohashi SN, DeLong JH, Kozberg MG, Mazur-Hart DJ, van Veluw SJ, Alkayed NJ, Sansing LH. Role of Inflammatory Processes in Hemorrhagic Stroke. Stroke 2023; 54:605-619. [PMID: 36601948 DOI: 10.1161/strokeaha.122.037155] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Hemorrhagic stroke is the deadliest form of stroke and includes the subtypes of intracerebral hemorrhage and subarachnoid hemorrhage. A common cause of hemorrhagic stroke in older individuals is cerebral amyloid angiopathy. Intracerebral hemorrhage and subarachnoid hemorrhage both lead to the rapid collection of blood in the central nervous system and generate inflammatory immune responses that involve both brain resident and infiltrating immune cells. These responses are complex and can contribute to both tissue recovery and tissue injury. Despite the interconnectedness of these major subtypes of hemorrhagic stroke, few reviews have discussed them collectively. The present review provides an update on inflammatory processes that occur in response to intracerebral hemorrhage and subarachnoid hemorrhage, and the role of inflammation in the pathophysiology of cerebral amyloid angiopathy-related hemorrhage. The goal is to highlight inflammatory processes that underlie disease pathology and recovery. We aim to discuss recent advances in our understanding of these conditions and identify gaps in knowledge with the potential to develop effective therapeutic strategies.
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Affiliation(s)
- Sarah N Ohashi
- Department of Neurology (S.N.O., J.H.D., L.H.S.), Yale School of Medicine, New Haven, CT
- Department of Immunobiology (S.N.O., J.H.D., L.H.S.), Yale School of Medicine, New Haven, CT
| | - Jonathan H DeLong
- Department of Neurology (S.N.O., J.H.D., L.H.S.), Yale School of Medicine, New Haven, CT
- Department of Immunobiology (S.N.O., J.H.D., L.H.S.), Yale School of Medicine, New Haven, CT
| | - Mariel G Kozberg
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital/ Harvard Medical School, Boston (M.G.K., S.J.v.V.)
- MassGeneral Institute for Neurodegenerative Disease, Department of Neurology, Massachusetts General Hospital, Charlestown (M.G.K., S.J.v.V.)
| | - David J Mazur-Hart
- Department of Neurological Surgery (D.J.M.-H.), Oregon Health and Science University (OHSU), Portland
| | - Susanne J van Veluw
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital/ Harvard Medical School, Boston (M.G.K., S.J.v.V.)
- MassGeneral Institute for Neurodegenerative Disease, Department of Neurology, Massachusetts General Hospital, Charlestown (M.G.K., S.J.v.V.)
| | - Nabil J Alkayed
- Department of Anesthesiology & Perioperative Medicine and Knight Cardiovascular Institute (N.J.A.), Oregon Health and Science University (OHSU), Portland
| | - Lauren H Sansing
- Department of Neurology (S.N.O., J.H.D., L.H.S.), Yale School of Medicine, New Haven, CT
- Department of Immunobiology (S.N.O., J.H.D., L.H.S.), Yale School of Medicine, New Haven, CT
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19
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Rudilosso S, Chui E, Stringer MS, Thrippleton M, Chappell F, Blair GW, Garcia DJ, Doubal F, Hamilton I, Kopczak A, Ingrisch M, Kerkhofs D, Backes WH, Staals J, van Oostenbrugge R, Duering M, Dichgans M, Wardlaw JM. Prevalence and Significance of the Vessel-Cluster Sign on Susceptibility-Weighted Imaging in Patients With Severe Small Vessel Disease. Neurology 2022; 99:e440-e452. [PMID: 35606147 PMCID: PMC9421604 DOI: 10.1212/wnl.0000000000200614] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/15/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Magnetic resonance susceptibility-weighted imaging (SWI) can identify small brain blood vessels that contain deoxygenated blood due to its induced magnetic field disturbance. We observed focal clusters of possible dilated small vessels on SWI in white matter in severe small vessel disease (SVD). We assessed their prevalence, associations with SVD lesions, and vascular reactivity in patients with sporadic SVD and in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). METHODS Secondary cross-sectional analysis of a prospective multicenter observational study of patients with either sporadic SVD or CADASIL (INVESTIGATE-SVD) studied with 3 Tesla MRI including blood-oxygen-level-dependent MRI cerebrovascular reactivity (CVR). Two independent raters evaluated SWI sequences to identify "vessel-clusters" in white matter as focal low-signal dots/lines with small vessel appearance (interrater agreement, kappa statistic = 0.66). We assessed per-patient and per-cluster associations with SVD lesion type and severity on structural MRI sequences. We also assessed CVR within and at 2-voxel concentric intervals around the vessel-clusters using contralateral volumes as a reference. RESULTS Among the 77 patients enrolled, 76 had usable SWI sequences, 45 with sporadic SVD (mean age 64 years [SD 11], 26 men [58%]) and 31 with CADASIL (53 years [11], 15 men [48%]). We identified 94 vessel-clusters in 36 of the 76 patients (15/45 sporadic SVD, 21/31 CADASIL). In covariate-adjusted analysis, patients with vessel-clusters had more lacunes (OR, 95% CI) (1.30, 1.05-1.62), higher white matter hyperintensity (WMH) volume (per-log10 increase, 1.92, 1.04-3.56), and lower CVR in normal appearing white matter (per %/mm Hg, 0.77, 0.60-0.99), compared with patients without vessel-clusters. Fifty-seven of the 94 vessel-clusters (61%) corresponded to noncavitated or partially cavitated WMH on fluid-attenuated inversion recovery, and 37 of 94 (39%) to complete cavities. CVR magnitude was lower than in the corresponding contralateral volumes (mean difference [SD], t, p) within vessel-cluster volumes (-0.00046 [0.00088], -3.021, 0.005) and in the surrounding volume expansion shells up to 4 voxels (-0.00011 [0.00031], -2.140, 0.039; -0.00010 [0.00027], -2.295, 0.028) in vessel-clusters with complete cavities, but not in vessel-clusters without complete cavitation. DISCUSSION Vessel-clusters might correspond to maximally dilated vessels in white matter that are approaching complete tissue injury and cavitation. The pathophysiologic significance of this new feature warrants further longitudinal investigation.
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Affiliation(s)
- Salvatore Rudilosso
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Ernest Chui
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Michael S Stringer
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Michael Thrippleton
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Francesca Chappell
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Gordon W Blair
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Daniela Jaime Garcia
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Fergus Doubal
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Iona Hamilton
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Anna Kopczak
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Michael Ingrisch
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Danielle Kerkhofs
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Walter H Backes
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Julie Staals
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Robert van Oostenbrugge
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Marco Duering
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Martin Dichgans
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany
| | - Joanna M Wardlaw
- From the Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS)(S.R.), Barcelona, Spain; Centre for Clinical Brain Sciences (E.C., M.S.S., M.T., F.C., G.B., D.J.G., F.D., I.H., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (A.K., M. Dichgans), University Hospital, LMU Munich; Department of Radiology (M.I.),Ludwig-Maximilians-University Hospital Munich, Germany; Department of Neurology (D.K., J.S., R.v.O.), CARIM-School for Cardiovascular Diseases Maastricht University Medical Center+, Maastricht,; Department of Radiology & Nuclear Medicine (W.H.B.), School for Mental Health & Neuroscience and School for Cardiovascular Diseases, Maastricht University Medical Centre, Netherlands; Institute for Stroke and Dementia Research (ISD) (M. Duering), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M. Duering), University of Basel, Switzerland; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans), Munich, Germany.
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20
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Cerebral small vessel disease alters neurovascular unit regulation of microcirculation integrity involved in vascular cognitive impairment. Neurobiol Dis 2022; 170:105750. [DOI: 10.1016/j.nbd.2022.105750] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/09/2022] [Accepted: 05/08/2022] [Indexed: 12/25/2022] Open
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21
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Vemuri P, Decarli CS, Duering M. Imaging Markers of Vascular Brain Health: Quantification, Clinical Implications, and Future Directions. Stroke 2022; 53:416-426. [PMID: 35000423 PMCID: PMC8830603 DOI: 10.1161/strokeaha.120.032611] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Cerebrovascular disease (CVD) manifests through a broad spectrum of mechanisms that negatively impact brain and cognitive health. Oftentimes, CVD changes (excluding acute stroke) are insufficiently considered in aging and dementia studies which can lead to an incomplete picture of the etiologies contributing to the burden of cognitive impairment. Our goal with this focused review is 3-fold. First, we provide a research update on the current magnetic resonance imaging methods that can measure CVD lesions as well as early CVD-related brain injury specifically related to small vessel disease. Second, we discuss the clinical implications and relevance of these CVD imaging markers for cognitive decline, incident dementia, and disease progression in Alzheimer disease, and Alzheimer-related dementias. Finally, we present our perspective on the outlook and challenges that remain in the field. With the increased research interest in this area, we believe that reliable CVD imaging biomarkers for aging and dementia studies are on the horizon.
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Affiliation(s)
| | - Charles S. Decarli
- Departments of Neurology and Center for Neuroscience, University of California at Davis, Sacramento, California, USA
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany
- Medical Image Analysis Center (MIAC AG) and qbig, Department of Biomedical Engineering, University of Basel, Switzerland
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22
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van Veluw SJ, Arfanakis K, Schneider JA. Neuropathology of Vascular Brain Health: Insights From Ex Vivo Magnetic Resonance Imaging-Histopathology Studies in Cerebral Small Vessel Disease. Stroke 2022; 53:404-415. [PMID: 35000425 PMCID: PMC8830602 DOI: 10.1161/strokeaha.121.032608] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Sporadic cerebral small vessel disease (SVD) is a major contributor to vascular cognitive impairment and dementia in the aging human brain. On neuropathology, sporadic SVD is characterized by abnormalities to the small vessels of the brain predominantly in the form of cerebral amyloid angiopathy and arteriolosclerosis. These pathologies frequently coexist with Alzheimer disease changes, such as plaques and tangles, in a single brain. Conversely, during life, magnetic resonance imaging (MRI) only captures the larger manifestations of SVD in the form of parenchymal brain abnormalities. There appears to be a major knowledge gap regarding the underlying neuropathology of individual MRI-detectable SVD abnormalities. Ex vivo MRI in postmortem human brain tissue is a powerful tool to bridge this gap. This review summarizes current insights into the histopathologic correlations of MRI manifestations of SVD, their underlying cause, presumed pathophysiology, and associated secondary tissue injury. Moreover, we discuss the advantages and limitations of ex vivo MRI-guided histopathologic investigations and make recommendations for future studies.
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Affiliation(s)
- Susanne J. van Veluw
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Charlestown, MA, USA,Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Konstantinos Arfanakis
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA,Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Julie A. Schneider
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA,Departments of Pathology and Neurological Sciences, Rush University Medical Center, Chicago IL, USA
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23
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Mazzacane F, Mazzoleni V, Scola E, Mancini S, Lombardo I, Busto G, Rognone E, Pichiecchio A, Padovani A, Morotti A, Fainardi E. Vessel Wall Magnetic Resonance Imaging in Cerebrovascular Diseases. Diagnostics (Basel) 2022; 12:diagnostics12020258. [PMID: 35204348 PMCID: PMC8871392 DOI: 10.3390/diagnostics12020258] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/08/2022] [Accepted: 01/14/2022] [Indexed: 01/27/2023] Open
Abstract
Cerebrovascular diseases are a leading cause of disability and death worldwide. The definition of stroke etiology is mandatory to predict outcome and guide therapeutic decisions. The diagnosis of pathological processes involving intracranial arteries is especially challenging, and the visualization of intracranial arteries’ vessel walls is not possible with routine imaging techniques. Vessel wall magnetic resonance imaging (VW-MRI) uses high-resolution, multiparametric MRI sequences to directly visualize intracranial arteries walls and their pathological alterations, allowing a better characterization of their pathology. VW-MRI demonstrated a wide range of clinical applications in acute cerebrovascular disease. Above all, it can be of great utility in the differential diagnosis of atherosclerotic and non-atherosclerotic intracranial vasculopathies. Additionally, it can be useful in the risk stratification of intracranial atherosclerotic lesions and to assess the risk of rupture of intracranial aneurysms. Recent advances in MRI technology made it more available, but larger studies are still needed to maximize its use in daily clinical practice.
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Affiliation(s)
- Federico Mazzacane
- Department of Emergency Neurology and Stroke Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy;
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Valentina Mazzoleni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy; (V.M.); (A.P.)
- Neurology Unit, Department of Neurological Sciences and Vision, ASST-Spedali Civili, 25123 Brescia, Italy;
| | - Elisa Scola
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (E.S.); (S.M.); (I.L.); (G.B.)
| | - Sara Mancini
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (E.S.); (S.M.); (I.L.); (G.B.)
| | - Ivano Lombardo
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (E.S.); (S.M.); (I.L.); (G.B.)
| | - Giorgio Busto
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (E.S.); (S.M.); (I.L.); (G.B.)
| | - Elisa Rognone
- Department of Neuroradiology, IRCCS Mondino Foundation, 27100 Pavia, Italy;
| | - Anna Pichiecchio
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy;
- Department of Neuroradiology, IRCCS Mondino Foundation, 27100 Pavia, Italy;
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy; (V.M.); (A.P.)
- Neurology Unit, Department of Neurological Sciences and Vision, ASST-Spedali Civili, 25123 Brescia, Italy;
| | - Andrea Morotti
- Neurology Unit, Department of Neurological Sciences and Vision, ASST-Spedali Civili, 25123 Brescia, Italy;
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50121 Florence, Italy
- Correspondence:
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24
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Bown CW, Carare RO, Schrag MS, Jefferson AL. Physiology and Clinical Relevance of Enlarged Perivascular Spaces in the Aging Brain. Neurology 2022; 98:107-117. [PMID: 34810243 PMCID: PMC8792814 DOI: 10.1212/wnl.0000000000013077] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/29/2021] [Indexed: 01/21/2023] Open
Abstract
Perivascular spaces (PVS) are fluid-filled compartments that are part of the cerebral blood vessel wall and represent the conduit for fluid transport in and out of the brain. PVS are considered pathologic when sufficiently enlarged to be visible on MRI. Recent studies have demonstrated that enlarged PVS (ePVS) may have clinical consequences related to cognition. Emerging literature points to arterial stiffening and abnormal protein aggregation in vessel walls as 2 possible mechanisms that drive ePVS formation. We describe the clinical consequences, anatomy, fluid dynamics, physiology, risk factors, and in vivo quantification methods of ePVS. Given competing views of PVS physiology, we detail the 2 most prominent theoretical views and review ePVS associations with other common small vessel disease markers. Because ePVS are a marker of small vessel disease and ePVS burden is higher in Alzheimer disease, a comprehensive understanding about ePVS is essential in developing prevention and treatment strategies.
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Affiliation(s)
- Corey W Bown
- From Vanderbilt Memory and Alzheimer's Center (C.W.B., M.S.S., A.L.J.) and Department of Neurology (C.W.B., M.S.S., A.L.J.), Vanderbilt University Medical Center; Vanderbilt Brain Institute (C.W.B., M.S.S., A.L.J.), Vanderbilt University, Nashville, TN; and Department of Medicine (R.O.C.), University of Southampton, Hampshire, UK
| | - Roxana O Carare
- From Vanderbilt Memory and Alzheimer's Center (C.W.B., M.S.S., A.L.J.) and Department of Neurology (C.W.B., M.S.S., A.L.J.), Vanderbilt University Medical Center; Vanderbilt Brain Institute (C.W.B., M.S.S., A.L.J.), Vanderbilt University, Nashville, TN; and Department of Medicine (R.O.C.), University of Southampton, Hampshire, UK
| | - Matthew S Schrag
- From Vanderbilt Memory and Alzheimer's Center (C.W.B., M.S.S., A.L.J.) and Department of Neurology (C.W.B., M.S.S., A.L.J.), Vanderbilt University Medical Center; Vanderbilt Brain Institute (C.W.B., M.S.S., A.L.J.), Vanderbilt University, Nashville, TN; and Department of Medicine (R.O.C.), University of Southampton, Hampshire, UK
| | - Angela L Jefferson
- From Vanderbilt Memory and Alzheimer's Center (C.W.B., M.S.S., A.L.J.) and Department of Neurology (C.W.B., M.S.S., A.L.J.), Vanderbilt University Medical Center; Vanderbilt Brain Institute (C.W.B., M.S.S., A.L.J.), Vanderbilt University, Nashville, TN; and Department of Medicine (R.O.C.), University of Southampton, Hampshire, UK
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25
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Liang C, Wang J, Feng M, Zhang N, Guo L. White matter changes, duration of hypertension, and age are associated with cerebral microbleeds in patients with different stages of hypertension. Quant Imaging Med Surg 2022; 12:119-130. [PMID: 34993065 DOI: 10.21037/qims-21-28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/31/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND We aimed to investigate risk factors for the presence and number of cerebral microbleeds (CMBs) in patients with different stages of hypertension stages, with an emphasis on the relationship between white matter changes (WMCs) and CMBs. METHODS Since 2016, participants aged 40 years or more have been evaluated for the presence of CMBs using enhanced 3D multiecho GE T2*-weighted angiography (ESWAN) sequences. The Mann-Whitney U test and Pearson χ2 test were used to compare the clinical characteristics between the CMB and no-CMB patient groups. Furthermore, we used Spearman's rank correlation analysis to examine the associations between the degree of CMB severity and other important factors. RESULTS CMBs were detected in 110 (36.7%) of 300 participants. Among patients with stage 2 hypertension, the majority also had CMBs (61.8%, 68/110). CMBs were positively correlated with age, hypertension stage, duration of hypertension, WMCs, and silent cerebral infarction. Patients with grade 3 WMCs were significantly more likely to have CMBs than those without WMCs; this association was true for both patients with stage 1 and those with stage 2 hypertension. In patients with stage 1 or stage 2 hypertension lasting longer than 20 years, the majority had CMBs (69.0%, 29/42; 69.1%, 47/68). The results of binary logistic regression indicated that a more severe hypertension stage, longer duration of hypertension, aging, having silent cerebral infarction and higher values of WMC increase the likelihood of the occurrence of CMBs. CONCLUSIONS CMBs detected in hypertensive patients were more likely to occur in deep structures, and the grade of WMCs and duration of hypertension were more closely associated with the CMB degree than with age.
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Affiliation(s)
- Changhu Liang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jing Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Mengmeng Feng
- Department of Radiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Nan Zhang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Lingfei Guo
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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26
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Wang J, Payne SJ. Mathematical modelling of haemorrhagic transformation after ischaemic stroke. J Theor Biol 2021; 531:110920. [PMID: 34582828 DOI: 10.1016/j.jtbi.2021.110920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/15/2022]
Abstract
With an increasingly elderly population globally, the impacts of cerebrovascular diseases, such as stroke and dementia, become increasingly significant. Haemorrhagic transformation (HT) is one of the most common complications of ischaemic stroke that is caused by dysfunction of endothelial cells in the blood-brain barrier (BBB) and that can be exacerbated by thrombolytic therapy. Recent studies also suggest that HT can lead to an increase in intracranial pressure (ICP) and result in capillary compression. The aim of this study is to develop a mathematical model that can be used to simulate the consequence of HT over a range of vasculature length scales. We use a 2D vasculature model to investigate the severity of HT with different vascular geometry. The resulting model shows that the haematoma radius is approximately constant across different length scales (100-1000μm) and in good agreement with the available experimental data. In addition, this study identified that the effects of capillary compression do appear to have a significant impact on the leakage fraction of blood and hence act to restrain the development of a haematoma.
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Affiliation(s)
- Jiayu Wang
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK.
| | - Stephen J Payne
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
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27
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Chang Y, Liu J, Wang L, Li X, Wang Z, Lin M, Jin W, Zhu M, Xu B. Diagnostic Utility of Integrated 11C-Pittsburgh Compound B Positron Emission Tomography/Magnetic Resonance for Cerebral Amyloid Angiopathy: A Pilot Study. Front Aging Neurosci 2021; 13:721780. [PMID: 34899265 PMCID: PMC8660657 DOI: 10.3389/fnagi.2021.721780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: We aimed to compare amyloid deposition at the lobar cerebral microbleed (CMB) sites of cerebral amyloid angiopathy (CAA), Alzheimer’s disease (AD), and cognitively normal healthy controls (NC) and to propose a novel diagnostic method for differentiating CAA patients from AD patients with integrated 11C-Pittsburgh compound B (PIB) positron emission tomography (PET)/magnetic resonance (MR) and assess its diagnostic value. Methods: Nine CAA, 15 AD patients, and 15 NC subjects were enrolled in this study. Each subject underwent an 11C-PIB brain PET/MR examination. Susceptibility weighted imaging was assessed to detect CMB locations, and standardized uptake value ratios (SUVRs) were measured at these sites. Cortical PIB distributions were quantitatively evaluated. Patients with CAA, AD, and NC subjects were compared with global and regional cortical SUVRs at CMB cites. The diagnostic accuracy of MRI, PIB-PET, and PET/MR in differentiating CAA and AD was evaluated. Results: Lobar CMBs were detected in all the CAA patients, eight of the 15 AD patients (53.3%), and four of the 15 NC subjects (26.7%), respectively. The PIB deposition at CMB sites was significantly higher in CAA patients compared with AD patients and NC subjects in terms of SUVR (1.72 ± 0.10 vs. 1.42 ± 0.16 and 1.17 ± 0.08; p < 0.0001). The PIB deposition was associated with CMB locations and was greatest in the occipital and temporal regions of CAA patients. The global cortical PIB deposition was significantly higher in CAA than in NC subjects (1.66 ± 0.06 vs. 1.21 ± 0.06; p < 0.0001) and significantly lower than in AD patients (1.66 ± 0.06 vs. 1.86 ± 0.17; p < 0.0001). In contrast, the occipital/global PIB uptake ratio was significantly increased in CAA (occipital/global ratio, 1.05 ± 0.02) relative to AD patients (1.05 ± 0.02 vs. 0.99 ± 0.04; p < 0.001). PET/MR had a higher accuracy (sensitivity, 88.9%; specificity, 93.3%) than separate PET and MR. Conclusion: Our results indicate that the CMBs occur preferentially at loci with concentrated amyloid. By combining lobar CMBs with regional cortical amyloid deposition, the proposed workflow can further improve CAA diagnostic accuracy compared to each method alone. These findings improve our knowledge regarding the pathogenesis of CMBs and highlight the potential utility of PIB-PET/MR as a non-invasive tool for distinguishing CAA and AD patients.
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Affiliation(s)
- Yan Chang
- Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jiajin Liu
- Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Liang Wang
- PET/CT, Jixi Ji Mine Hospital, Jixi, China
| | - Xin Li
- Department of Interventional Radiology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Zhenjun Wang
- Department of Radiology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Mu Lin
- MR Collaboration, Diagnostic Imaging, Siemens Healthcare Ltd., Shanghai, China
| | - Wei Jin
- Department of Pathology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Mingwei Zhu
- Department of Neurology Medicine, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Baixuan Xu
- Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
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28
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Dallaire-Théroux C, Saikali S, Richer M, Potvin O, Duchesne S. Histopathological Analysis of Cerebrovascular Lesions Associated With Aging. J Neuropathol Exp Neurol 2021; 81:97-105. [PMID: 34875082 DOI: 10.1093/jnen/nlab125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Cerebrovascular disease (CVD) has been associated with cognitive impairment. Yet, our understanding of vascular contribution to cognitive decline has been limited by heterogeneity of definitions and assessment, as well as its occurrence in cognitively healthy aging. Therefore, we aimed to establish the natural progression of CVD associated with aging. We conducted a retrospective observational study of 63 cognitively healthy participants aged 19-84 years selected through the histological archives of the CHU de Québec. Assessment of CVD lesions was performed independently by 3 observers blinded to clinical data using the Vascular Cognitive Impairment Neuropathology Guidelines (VCING). We found moderate to almost perfect interobserver agreement for most regional CVD scores. Atherosclerosis (ρ = 0.758) and arteriolosclerosis (ρ = 0.708) showed the greatest significant association with age, followed by perivascular hemosiderin deposits (ρ = 0.432) and cerebral amyloid angiopathy (CAA; ρ = 0.392). Amyloid and tau pathologies were both associated with higher CVD load, but only CAA remained significantly associated with amyloid plaques after controlling for age. Altogether, these findings support the presence of multiple CVD lesions in the brains of cognitively healthy adults, the burden of which increases with age and can be quantified in a reproducible manner using standardized histological scales such as the VCING.
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Affiliation(s)
- Caroline Dallaire-Théroux
- From the CERVO Brain Research Center, Quebec City, Quebec, Canada (CD-T, OP, SD); Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada (CD-T, SS, MR); Department of Neurological Sciences, Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada (CD-T); Department of Pathology, Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada (SS, MR); and Department of Radiology and nuclear medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada (SD)
| | - Stephan Saikali
- From the CERVO Brain Research Center, Quebec City, Quebec, Canada (CD-T, OP, SD); Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada (CD-T, SS, MR); Department of Neurological Sciences, Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada (CD-T); Department of Pathology, Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada (SS, MR); and Department of Radiology and nuclear medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada (SD)
| | - Maxime Richer
- From the CERVO Brain Research Center, Quebec City, Quebec, Canada (CD-T, OP, SD); Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada (CD-T, SS, MR); Department of Neurological Sciences, Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada (CD-T); Department of Pathology, Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada (SS, MR); and Department of Radiology and nuclear medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada (SD)
| | - Olivier Potvin
- From the CERVO Brain Research Center, Quebec City, Quebec, Canada (CD-T, OP, SD); Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada (CD-T, SS, MR); Department of Neurological Sciences, Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada (CD-T); Department of Pathology, Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada (SS, MR); and Department of Radiology and nuclear medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada (SD)
| | - Simon Duchesne
- From the CERVO Brain Research Center, Quebec City, Quebec, Canada (CD-T, OP, SD); Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada (CD-T, SS, MR); Department of Neurological Sciences, Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada (CD-T); Department of Pathology, Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada (SS, MR); and Department of Radiology and nuclear medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada (SD)
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29
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Spindler M, Thiel CM. Quantitative magnetic resonance imaging for segmentation and white matter extraction of the hypothalamus. J Neurosci Res 2021; 100:564-577. [PMID: 34850453 DOI: 10.1002/jnr.24988] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 10/05/2021] [Accepted: 10/12/2021] [Indexed: 11/09/2022]
Abstract
Since the hypothalamus is involved in many neuroendocrine, metabolic, and affective disorders, detailed hypothalamic imaging has become of major interest to better characterize disease-induced tissue damages and abnormalities. Still, image contrast of conventional anatomical magnetic resonance imaging lacks morphological detail, thus complicating complete and precise segmentation of the hypothalamus. The hypothalamus' position lateral to the third ventricle and close proximity to white matter tracts including the optic tract, fornix, and mammillothalamic tract display one of the remaining shortcomings of hypothalamic segmentation, as reliable exclusion of white matter is not yet possible. Recent studies found that quantitative magnetic resonance imaging (qMRI), a method to create maps of different standardized tissue contents, improved segmentation of cortical and subcortical brain regions. So far, this has not been tested for the hypothalamus. Therefore, in this study, we investigated the usability of qMRI and diffusion MRI for the purpose of detailed and reproducible manual segmentation of the hypothalamus and data-driven white matter extraction and compared our results to recent state-of-the-art segmentations. Our results show that qMRI presents good contrast for delineation of the hypothalamus and white matter, and that the properties of these images differ between subunits, such that they can be used to reliably exclude white matter from hypothalamic tissue. We propose that qMRI poses a useful addition to detailed hypothalamic segmentation and volumetry.
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Affiliation(s)
- Melanie Spindler
- Biological Psychology, Department of Psychology, School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Christiane M Thiel
- Biological Psychology, Department of Psychology, School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany.,Cluster of Excellence "Hearing4all", Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany.,Research Centre Neurosensory Science, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
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30
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Yokoyama R, Kanzaki Y, Watanabe T, Yamamura K, Komori T, Takeda Y, Nakajima O, Sohmiya K, Hoshiga M. Prevalence and Risk Factors of Silent Cerebral Microbleeds in Patients with Coronary Artery Disease. J Stroke Cerebrovasc Dis 2021; 31:106211. [PMID: 34823092 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 10/20/2021] [Accepted: 10/31/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Cerebral microbleeds (CMBs), which can be detected by gradient-echo T2*-weighted magnetic resonance imaging (MRI), represent small chronic brain hemorrhages caused by structural abnormalities in cerebral small vessels. CMBs are known to be a potential predictor of future stroke, and are associated with age, various cardiovascular risk factors, cognitive impairment, and the use of antithrombotic drugs. Patients with coronary artery disease (CAD) are at potentially high risk of CMBs due to the presence of coexistent conditions. However, little is known about CMBs in patients with CAD. We aimed to identify the factors associated with the presence of CMBs among patients with CAD. METHODS We evaluated 356 consecutive patients [mean age, 72 ± 10 years; men = 276 (78%)] with angiographically proven CAD who underwent T2*-weighted brain MRI. The brain MRI was assessed by researchers blinded to the patients' clinical details. RESULTS CMBs were found in 128 (36%) patients. Among 356 patients, 119 (33%) had previously undergone percutaneous coronary intervention (PCI), and 26 (7%) coronary artery bypass grafting (CABG). There was no significant relationship between CMBs and sex, hypertension, dyslipidemia, diabetes mellitus, anticoagulation therapy, antiplatelet therapy, or prior PCI. CMBs were significantly associated with advanced age, previous CABG, eGFR, non-HDL cholesterol, carotid artery disease, long-term antiplatelet therapy, and long-term dual antiplatelet therapy (DAPT) using univariate logistic regression analysis. The multivariate logistic regression analysis showed that long-term antiplatelet therapy (odds ratio, 1.73; 95% CI, 1.06 - 2.84; P = 0.03) or long-term DAPT (odds ratio, 2.92; 95% CI, 1.39 - 6.17; P = 0.004) was significantly associated with CMBs after adjustment for confounding variables. CONCLUSIONS CMBs were frequently observed in patients with CAD and were significantly associated with long-term antiplatelet therapy, especially long-term DAPT.
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Affiliation(s)
- Ryo Yokoyama
- Departments of Cardiology, Osaka Medical and Pharmaceutical University, Japan; Department of Cardiology, Hirakata City Hospital
| | - Yumiko Kanzaki
- Departments of Cardiology, Osaka Medical and Pharmaceutical University, Japan.
| | - Tomohiko Watanabe
- Departments of Cardiology, Osaka Medical and Pharmaceutical University, Japan
| | - Kenichiro Yamamura
- Departments of Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Tsuyoshi Komori
- Departments of Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Yoshihiro Takeda
- Departments of Cardiology, Osaka Medical and Pharmaceutical University, Japan; Department of Cardiology, Hirakata City Hospital
| | | | - Koichi Sohmiya
- Departments of Cardiology, Osaka Medical and Pharmaceutical University, Japan
| | - Masaaki Hoshiga
- Departments of Cardiology, Osaka Medical and Pharmaceutical University, Japan
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31
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Balzano RF, Mannatrizio D, Castorani G, Perri M, Pennelli AM, Izzo R, Popolizio T, Guglielmi G. Imaging of Cerebral Microbleeds: Primary Patterns and Differential Diagnosis. CURRENT RADIOLOGY REPORTS 2021. [DOI: 10.1007/s40134-021-00390-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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32
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Management of Intracerebral Hemorrhage: Update and Future Therapies. Curr Neurol Neurosci Rep 2021; 21:57. [PMID: 34599652 DOI: 10.1007/s11910-021-01144-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Intracerebral hemorrhage (ICH) represents about 15% of all strokes in the USA, but almost 50% of fatal strokes. There are many causes of ICH, but the most common are hypertension and cerebral amyloid angiopathy. This review will discuss new advances in the treatment of intracerebral hemorrhage. RECENT FINDINGS The treatment of ICH focuses on management of edema, aggressive blood pressure reduction, and correction of coagulopathy. Early initiation of supportive medical therapies, including blood pressure management, in a neurological intensive care unit reduces mortality, but at present there is no definitive, curative therapy analogous to mechanical thrombectomy for ischemic stroke. Nonetheless, new medical and surgical approaches promise more successful management of ICH patients, especially new approaches to surgical management. In this review, we focus on the current standard of care of acute ICH and discuss emerging therapies that may alter the landscape of this devastating disease.
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Kang N, Qiao Y, Wasserman BA. Essentials for Interpreting Intracranial Vessel Wall MRI Results: State of the Art. Radiology 2021; 300:492-505. [PMID: 34313475 DOI: 10.1148/radiol.2021204096] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Intracranial vessel wall (VW) MRI has become widely available in clinical practice, providing multiple uses for evaluation of neurovascular diseases. The Vessel Wall Imaging Study Group of the American Society of Neuroradiology has recently reported expert consensus recommendations for the clinical implementation of this technique. However, the complexity of the neurovascular system and caveats to the technique may challenge its application in clinical practice. The purpose of this article is to review concepts essential for accurate interpretation of intracranial VW MRI results. This knowledge is intended to improve diagnostic confidence and performance in the interpretation of VW MRI scans. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Ningdong Kang
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, HSF III 8106, 670 W Baltimore St, Baltimore, MD, 21201 (B.A.W.). Russell H. Morgan Department of Radiology & Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD. (N.K., Y.Q., B.A.W.)
| | - Ye Qiao
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, HSF III 8106, 670 W Baltimore St, Baltimore, MD, 21201 (B.A.W.). Russell H. Morgan Department of Radiology & Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD. (N.K., Y.Q., B.A.W.)
| | - Bruce A Wasserman
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, HSF III 8106, 670 W Baltimore St, Baltimore, MD, 21201 (B.A.W.). Russell H. Morgan Department of Radiology & Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD. (N.K., Y.Q., B.A.W.)
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Fe/Mn Multilayer Nanowires as High-Performance T 1-T 2 Dual Modal MRI Contrast Agents. MATERIALS 2021; 14:ma14092238. [PMID: 33925382 PMCID: PMC8123899 DOI: 10.3390/ma14092238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/20/2021] [Accepted: 04/20/2021] [Indexed: 12/30/2022]
Abstract
A lot of nanomaterials are using T1-T2 dual mode magnetic resonance (MR) contrast agents (CAs), but multilayer nanowire (NW) with iron (Fe) and manganese (Mn) as T1-T2 dual modal CAs has not been reported yet. Herein, we synthesized a Fe/Mn multilayer NW with an adjustable Fe layer, as T1-T2 dual-mode CAs. The relaxation performance of Fe/Mn multilayer NW was studied at 1.5 T. Results show that, when the length of the Fe layer is about 10 nm and the Mn is about 5 nm, the r1 value (21.8 mM−1s−1) and r2 value (74.8 mM−1s−1) of the Fe/Mn multilayer NW are higher than that of Mn NW (3.7 mM−1s−1) and Fe NW (59.3 mM−1s−1), respectively. We predict that our Fe/Mn multilayer NW could be used as T1-T2 dual mode MRI CAs in the near future.
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35
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Puy L, Pasi M, Rodrigues M, van Veluw SJ, Tsivgoulis G, Shoamanesh A, Cordonnier C. Cerebral microbleeds: from depiction to interpretation. J Neurol Neurosurg Psychiatry 2021; 92:jnnp-2020-323951. [PMID: 33563804 DOI: 10.1136/jnnp-2020-323951] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/22/2020] [Accepted: 01/04/2021] [Indexed: 11/04/2022]
Abstract
Cerebral microbleeds (CMBs) are defined as hypointense foci visible on T2*-weighted and susceptible-weighted MRI sequences. CMBs are increasingly recognised with the widespread use of MRI in healthy individuals as well as in the context of cerebrovascular disease or dementia. They can also be encountered in major critical medical conditions such as in patients requiring extracorporeal mechanical oxygenation. The advent of MRI-guided postmortem neuropathological examinations confirmed that, in the context of cerebrovascular disease, the vast majority of CMBs correspond to recent or old microhaemorrhages. Detection of CMBs is highly influenced by MRI parameters, in particular field strength, postprocessing methods used to enhance T2* contrast and three dimensional sequences. Despite recent progress, harmonising imaging parameters across research studies remains necessary to improve cross-study comparisons. CMBs are helpful markers to identify the nature and the severity of the underlying chronic small vessel disease. In daily clinical practice, presence and numbers of CMBs often trigger uncertainty for clinicians especially when antithrombotic treatments and acute reperfusion therapies are discussed. In the present review, we discuss those clinical dilemmas and address the value of CMBs as diagnostic and prognostic markers for future vascular events.
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Affiliation(s)
- Laurent Puy
- Department of Neurology, U1172 - LilNCog - Lille Neuroscience & Cognition, Univ. Lille, Inserm, CHU Lille, F-59000 Lille, France
| | - Marco Pasi
- Department of Neurology, U1172 - LilNCog - Lille Neuroscience & Cognition, Univ. Lille, Inserm, CHU Lille, F-59000 Lille, France
| | - Mark Rodrigues
- Centre for Clinical Brain Sciences, The University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, Midlothian, UK
| | - Susanne J van Veluw
- Neurology Department, Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Ashkan Shoamanesh
- Department of Medicine (Neurology), McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada
| | - Charlotte Cordonnier
- Department of Neurology, U1172 - LilNCog - Lille Neuroscience & Cognition, Univ. Lille, Inserm, CHU Lille, F-59000 Lille, France
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Fan F, Yang C, Zhu X, Liu Z, Liu H, Li J, Jiang R, Zhang Y, Bu X, Wang Y, Wang Q, Xiang Y. Association between infectious burden and cerebral microbleeds: a pilot cross-sectional study. Ann Clin Transl Neurol 2021; 8:395-405. [PMID: 33410595 PMCID: PMC7886034 DOI: 10.1002/acn3.51285] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/07/2020] [Accepted: 12/03/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Cerebral microbleeds (CMBs) is a subtype of cerebral small vessel disease. Their underlying pathogenesis remains unclear. The aim of this study was to investigate the association between infectious burden (IB) and CMBs. METHODS Seven hundred and seventy-three consecutive patients who were hospitalized in the Department of Neurology in General Hospital of Western Theater Command without severe neurological symptoms were recruited and selected in this pilot cross-sectional study. CMBs were assessed using the susceptibility-weighted imaging sequence of magnetic resonance imaging. Immunoglobulin G antibodies against common pathogens, including herpes simplex virus (HSV)-1, HSV-2, cytomegalovirus (CMV), Chlamydia pneumoniae (C. pneumoniae), Mycoplasma pneumoniae (M. pneumoniae), Epstein-Barr virus (EBV), Helicobacter pylori (HP), and Borrelia burgdorferi (B. burgdorferi), were measured by commercial ELISA assays. IB was defined as a composite serologic measure of exposure to these common pathogens. RESULTS Patients with and without CMBs were defined as the CMBs group (n = 76) and the non-CMBs group (n = 81), respectively. IB was significantly different between the CMBs and non-CMBs groups. After adjusted for other risk factors, the increased IB was independently associated with the presence of CMBs (P = 0.031, OR = 3.00, 95% CI [1.11-8.15]). IB was significantly positively associated with the number of CMBs (Spearman ρ = 0.653, P < 0.001). The levels of serum inflammatory markers were significantly different between the CMBs and non-CMBs groups and among the categories of IB. INTERPRETATION IB consisting of HSV-1, HSV-2, CMV, C. pneumoniae, M. pneumoniae, EBV, HP, and B. burgdorferi was associated with CMBs. All the findings suggested that pathogen infection could be involved in the pathogenesis of CMBs.
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Affiliation(s)
- Fan Fan
- Department of Neurology, Huanggang Central Hospital, Huanggang, Hubei, China.,Department of Neurology, General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Cui Yang
- Department of Neurology, General Hospital of Western Theater Command, Chengdu, Sichuan, China.,Institute of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.,Institute of Neurology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China
| | - Xiaoyan Zhu
- Basic Medical Laboratory, General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Zhilan Liu
- Department of Neurology, General Hospital of Western Theater Command, Chengdu, Sichuan, China.,Department of Clinical Medicine, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Hui Liu
- Department of Neurology, General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Jianhao Li
- Department of Radiology, General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Rui Jiang
- Department of Radiology, General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Yaolei Zhang
- Basic Medical Laboratory, General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Xianle Bu
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yanjiang Wang
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Qingsong Wang
- Department of Neurology, General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Yang Xiang
- Department of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
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Graff-Radford J, Lesnick TG, Mielke MM, Constantopoulos E, Rabinstein A, Przybelski SA, Vemuri P, Botha H, Jones DT, Ramanan VK, Petersen RC, Knopman DS, Boeve BF, Murray ME, Dickson DW, Jack CR, Kantarci K, Reichard RR. Cerebral Amyloid Angiopathy Burden and Cerebral Microbleeds: Pathological Evidence for Distinct Phenotypes. J Alzheimers Dis 2021; 81:113-122. [PMID: 33720897 PMCID: PMC8113155 DOI: 10.3233/jad-201536] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The relationship between cerebral microbleeds (CMBs) on hemosiderin-sensitive MRI sequences and cerebral amyloid angiopathy (CAA) remains unclear in population-based participants or in individuals with dementia. OBJECTIVE To determine whether CMBs on antemortem MRI correlate with CAA. METHODS We reviewed 54 consecutive participants with antemortem T2*GRE-MRI sequences and subsequent autopsy. CMBs were quantified on MRIs closest to death. Autopsy CAA burden was quantified in each region including leptomeningeal/cortical and capillary CAA. By a clustering approach, we examined the relationship among CAA variables and performed principal component analysis (PCA) for dimension reduction to produce two scores from these 15 interrelated predictors. Hurdle models assessed relationships between principal components and lobar CMBs. RESULTS MRI-based CMBs appeared in 20/54 (37%). 10 participants had ≥2 lobar-only CMBs. The first two components of the PCA analysis of the CAA variables explained 74% variability. The first rotated component (RPC1) consisted of leptomeningeal and cortical CAA and the second rotated component of capillary CAA (RPC2). Both the leptomeningeal and cortical component and the capillary component correlated with lobar-only CMBs. The capillary CAA component outperformed the leptomeningeal and cortical CAA component in predicting lobar CMBs. Both capillary and the leptomeningeal/cortical components correlated with number of lobar CMBs. CONCLUSION Capillary and leptomeningeal/cortical scores correlated with lobar CMBs on MRI but lobar CMBs were more closely associated with the capillary component. The capillary component correlated with APOEɛ4, highlighting lobar CMBs as one aspect of CAA phenotypic diversity. More CMBs also increase the probability of underlying CAA.
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Affiliation(s)
| | | | - Michelle M. Mielke
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
- Department of Health Sciences Research
| | | | | | | | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - David T. Jones
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | - Melissa E. Murray
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Jacksonville, Florida
| | - Dennis W. Dickson
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Jacksonville, Florida
| | | | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - R. Ross Reichard
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, Minnesota
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Nag S, Chen EY, Johnson R, Tamhane A, Arfanakis K, Schneider JA. Ex vivo MRI facilitates localization of cerebral microbleeds of different ages during neuropathology assessment. FREE NEUROPATHOLOGY 2021; 2:2-35. [PMID: 37284642 PMCID: PMC10209859 DOI: 10.17879/freeneuropathology-2021-3638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/12/2021] [Indexed: 06/08/2023]
Abstract
Cerebral microbleeds (CMBs) identified by in vivo magnetic resonance imaging (MRI) of brains of older persons may have clinical relevance due to their association with cognitive impairment and other adverse neurologic outcomes, but are often not detected in routine neuropathology evaluations. In this study, the utility of ex vivo MRI in the neuropathological identification, localization, and frequency of CMBs was investigated. The study included 3 community dwelling elders with Alzheimer's dementia, and mild to severe small vessel disease (SVD). Ex vivo MRI was performed on the fixed hemisphere to identify CMBs, blinded to the neuropathology diagnoses. The hemibrains were then sliced at 1 cm intervals and 2, 1 or 0 microhemorrhages (MH) were detected on the cut surfaces of brain slabs using the routine neuropathology protocol. Ex vivo imaging detected 15, 14 and 9 possible CMBs in cases 1, 2 and 3, respectively. To obtain histological confirmation of the CMBs detected by ex vivo MRI, the 1 cm brain slabs were dissected further and MHs or areas corresponding to the CMBs detected by ex vivo MRI were blocked and serially sectioned at 6 µm intervals. Macroscopic examination followed by microscopy post ex vivo MRI resulted in detection of 35 MHs and therefore, about 12 times as many MHs were detected compared to routine neuropathology assessment without ex vivo MRI. While microscopy identified previously unrecognized chronic MHs, it also showed that MHs were acute or subacute and therefore may represent perimortem events. Ex vivo MRI detected CMBs not otherwise identified on routine neuropathological examination of brains of older persons and histologic evaluation of the CMBs is necessary to determine the age and clinical relevance of each hemorrhage.
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Affiliation(s)
- Sukriti Nag
- Department of Pathology (Neuropathology), Rush University Medical Center, Chicago, ILUnited States
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, ILUnited States
| | - Er-Yun Chen
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, ILUnited States
| | - Ryan Johnson
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, ILUnited States
| | - Ashish Tamhane
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, ILUnited States
| | - Konstantinos Arfanakis
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, ILUnited States
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, ILUnited States
| | - Julie. A Schneider
- Department of Pathology (Neuropathology), Rush University Medical Center, Chicago, ILUnited States
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, ILUnited States
- Department of Neurological Sciences, Rush University Medical Center, Chicago, ILUnited States
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Management of Intracerebral Hemorrhage: JACC Focus Seminar. J Am Coll Cardiol 2020; 75:1819-1831. [PMID: 32299594 DOI: 10.1016/j.jacc.2019.10.066] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 10/27/2019] [Indexed: 01/12/2023]
Abstract
Intracerebral hemorrhage (ICH) accounts for a disproportionate amount of stroke-related morbidity and mortality. Although chronic hypertension and cerebral amyloid angiopathy are the underlying cerebral vasculopathies accounting for the majority of ICH, there are a broad range of potential causes, and effective management requires accurate identification and treatment of the underlying mechanism of hemorrhage. Magnetic resonance imaging and vascular imaging techniques play a critical role in identifying disease mechanisms. Modern treatment of ICH focuses on rapid stabilization, often requiring urgent treatment of mass effect, aggressive blood pressure reduction and correction of contributing coagulopathies to achieve hemostasis. We discuss management of patients with ICH who continue to require long-term anticoagulation, the interaction of ICH with neurodegenerative diseases, and our approach to prognostication after ICH. We close this review with a discussion of novel medical and surgical approaches to ICH treatment that are being tested in clinical trials.
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Nyúl-Tóth Á, Tarantini S, Kiss T, Toth P, Galvan V, Tarantini A, Yabluchanskiy A, Csiszar A, Ungvari Z. Increases in hypertension-induced cerebral microhemorrhages exacerbate gait dysfunction in a mouse model of Alzheimer's disease. GeroScience 2020; 42:1685-1698. [PMID: 32844283 PMCID: PMC7732885 DOI: 10.1007/s11357-020-00256-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/17/2020] [Indexed: 12/17/2022] Open
Abstract
Clinical studies show that cerebral amyloid angiopathy (CAA) associated with Alzheimer's disease (AD) and arterial hypertension are independent risk factors for cerebral microhemorrhages (CMHs). To test the hypothesis that amyloid pathology and hypertension interact to promote the development of CMHs, we induced hypertension in the Tg2576 mouse model of AD and respective controls by treatment with angiotensin II (Ang II) and the NO synthesis inhibitor L-NAME. The number, size, localization, and neurological consequences (gait alterations) of CMHs were compared. We found that compared to control mice, in TG2576 mice, the same level of hypertension led to significantly increased CMH burden and exacerbation of CMH-related gait alterations. In hypertensive TG2576 mice, CMHs were predominantly located in the cerebral cortex at the cortical-subcortical boundary, mimicking the clinical picture seen in patients with CAA. Collectively, amyloid pathologies exacerbate the effects of hypertension, promoting the genesis of CMHs, which likely contribute to their deleterious effects on cognitive function. Therapeutic strategies for prevention of CMHs that reduce blood pressure and preserve microvascular integrity are expected to exert neuroprotective effects in high-risk elderly AD patients.
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Affiliation(s)
- Ádám Nyúl-Tóth
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging/Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Institute of Biophysics, Biological Research Centre, Szeged, Hungary
| | - Stefano Tarantini
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging/Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Tamas Kiss
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging/Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Theoretical Medicine Doctoral School/Departments of Medical Physics and Informatics & Cell Biology and Molecular Medicine, University of Szeged, Szeged, Hungary
| | - Peter Toth
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging/Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- International Training Program in Geroscience, Doctoral School of Clinical Medicine, Department of Neurosurgery and Szentagothai Research Center, Medical School, University of Pecs, Pecs, Hungary
| | - Veronica Galvan
- Department of Cellular and Integrative Physiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Amber Tarantini
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging/Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Andriy Yabluchanskiy
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging/Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Anna Csiszar
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging/Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Theoretical Medicine Doctoral School/Departments of Medical Physics and Informatics & Cell Biology and Molecular Medicine, University of Szeged, Szeged, Hungary
| | - Zoltan Ungvari
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging/Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary.
- International Training Program in Geroscience, Theoretical Medicine Doctoral School/Departments of Medical Physics and Informatics & Cell Biology and Molecular Medicine, University of Szeged, Szeged, Hungary.
- Department of Biochemistry and Molecular Biology, Reynolds Oklahoma Center on Aging/Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA.
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Buciuc M, Duffy JR, Machulda MM, Spychalla AJ, Gunter JL, Jack CR, Giannini C, Raghunathan A, Dickson DW, Josephs KA, Whitwell JL. Association of amyloid angiopathy with microbleeds in logopenic progressive aphasia: an imaging-pathology study. Eur J Neurol 2020; 28:670-675. [PMID: 33068458 DOI: 10.1111/ene.14594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral microbleeds (MB) and superficial siderosis (SS) are frequent neuroimaging findings in patients with logopenic progressive aphasia (LPA), often with frontal lobe predilection. Cerebral amyloid angiopathy (CAA) is hypothesized to be the major pathologic determinant of MB/SS in these patients; however, neuroimaging-pathologic data are limited. METHODS All patients who had been prospectively recruited by the Neurodegenerative Research Group at the Mayo Clinic (Rochester, MN) between 2010 and 2015 and met the following inclusion criteria were included: (i) received an antemortem LPA diagnosis, (ii) had a gradient-recalled echo T2*-weighted magnetic resonance imaging (MRI) performed, (iii) died and completed a brain autopsy. Demographic, genetic, neuroimaging, and clinical and pathologic characteristics were compared between patients with/without MB/SS. Two-tailed Fisher exact and Wilcoxon rank sum tests were used for comparison of categorical and continuous variables, respectively. RESULTS Thirteen patients met inclusion criteria, six (46%) had MB/SS on MRI. Moderate/severe CAA was associated with the presence of MB/SS (p = 0.029). As expected, MB/SS most frequently involved the frontal lobes, followed by the parietal lobes. No clear associations were found between regional MB/SS distribution and regional distribution of CAA or hypometabolism on [18 F]-fluorodeoxyglucose-positron emission tomography. There was some evidence for a regional association between MB/SS and uptake on Pittsburgh compound B, although not in all patients. No formal statistical analyses to assess topographic relationships were performed due to the small sample size. CONCLUSIONS The presence of MB/SS is a strong indicator of underlying moderate/severe CAA in LPA, although the biological mechanisms underlying the topographic distribution of MB/SS remain unclear.
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Affiliation(s)
- M Buciuc
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - J R Duffy
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - M M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - A J Spychalla
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - J L Gunter
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - C R Jack
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - C Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - A Raghunathan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - D W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - K A Josephs
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - J L Whitwell
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Yao M, Zhao J, Jiang N, Li L, Ni J. Superficial Siderosis and Microbleed Restricted in Cortex Might Be Correlated to Atrophy and Cognitive Decline in Sneddon's Syndrome. Front Neurol 2020; 11:1035. [PMID: 33041979 PMCID: PMC7525095 DOI: 10.3389/fneur.2020.01035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/10/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: Sneddon's syndrome is a rare non-inflammatory arteriopathy affecting small and medium-sized arteries, characterized by a generalized livedo reticularis and recurrent transient ischemic attack or ischemic stroke. Hemorrhagic stroke was reported in limited cases, but microbleeds and superficial siderosis were rarely issued. We aimed to investigate the hemorrhagic imaging features of Sneddon's syndrome and explore the possible mechanism and clinical relevance. Methods: Clinical data and cerebral MR imaging including T2* sequence of seven consecutive patients with Sneddon's syndrome were reviewed. Results: The most common neurological manifestations were cognitive impairment and stroke attack (71.4%), followed by seizures and movement disorder (28.6%). Cerebral microbleeds were detected in six patients on T2* sequence, all of them presented with cortical microbleeds, only one of them with microbleeds in basal ganglion. More than five microbleeds were observed in four of these six patients. The majority of the microbleeds were predominantly cortical restricted and especially located in the cortical watersheds. Multiple superficial siderosis were identified mainly involving cortical watersheds in five cases. Significant cerebral atrophy with prominent secondary white matter hyperintensities in bilateral cortical watersheds were also observed. Abnormal tortuous and multiple focal occlusion of bilateral distal MCA were shown in one patient by DSA. No stenosis of proximal segment of cerebral arteries was detected in all the patients. Conclusions: This is the first report illustrating abundant cortical microbleeds and superficial siderosis mainly involved the anterior and posterior cortical watersheds in Sneddon's syndrome. The surprisingly identical topographic distribution of hemorrhagic lesions and the obvious atrophy suggest cerebral atrophy might be secondary to the microangiopathy related hemorrhagic lesions and further contribute to the neurological deficit, especially the early cognitive decline in Sneddon syndrome.
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Affiliation(s)
- Ming Yao
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jiuliang Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Nan Jiang
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Libo Li
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jun Ni
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Schrag M, Mac Grory B, Nackenoff A, Eaton J, Mistry E, Kirshner H, Yaghi S, Ellis CR. Left Atrial Appendage Closure for Patients with Cerebral Amyloid Angiopathy and Atrial Fibrillation: the LAA-CAA Cohort. Transl Stroke Res 2020; 12:259-265. [PMID: 32770310 DOI: 10.1007/s12975-020-00838-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 12/11/2022]
Abstract
Anticoagulation increases the risk of intracerebral hemorrhage (ICH) in patients with cerebral amyloid angiopathy (CAA), so the management of stroke-risk in patients with both atrial fibrillation (AF) and CAA is controversial. Advances in left atrial appendage closure (LAAC) techniques provide a stroke-risk-reduction option which avoids long-term oral anticoagulation (OAC). We aimed to evaluate the safety of this intervention in patients with CAA. This is an observational cohort study of patients with severe CAA (with or without ICH) and AF who were treated with LAA closure. The Watchman™ and Amulet® LAAC devices and Lariat procedure or open surgical closure of the LAA were all considered acceptable means of closure. Patients with symptomatic ICH and those naïve to anticoagulation were placed on clopidogrel and/or aspirin for 6 weeks after the procedure; patients who previously tolerated anticoagulation remained on warfarin or a DOAC for 6 weeks post-procedure. All anticoagulation therapy was discontinued after confirmation of LAAC. All patients had aggressively optimized blood pressure and fall precautions in addition to surgical intervention. Safety, tolerability, stroke, and hemorrhage rates were documented. Twenty-six patients with a mean CHA2DS2-VASc score of 4.6 were treated, 13 with a history of symptomatic lobar hemorrhage and 13 without. All patients who completed LAAC tolerated the device implantation. There were no documented ischemic strokes or symptomatic ICH during the 30 days after device implantation. Patients were followed for an average of 25 months. One patient who underwent Lariat LAAC had an ischemic stroke in follow-up, but recovered well; there were no other thromboemboli in this cohort. This cohort study provides evidence that LAAC appears to be a safe and tolerable treatment to reduce stroke risk in patients with CAA. Because of the small size of the cohort and relatively short follow-up, the efficacy for stroke and ICH prevention is not conclusive, but the preliminary results are encouraging. LAA closure may be a good alternative to anticoagulation in patients with CAA and atrial fibrillation.
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Affiliation(s)
- Matthew Schrag
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Brian Mac Grory
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Alex Nackenoff
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James Eaton
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eva Mistry
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Howard Kirshner
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shadi Yaghi
- Department of Neurology, New York University, New York, NY, USA
| | - Christopher R Ellis
- Department of Medicine, Cardiovascular Electrophysiology section, Vanderbilt University Medical Center, Nashville, TN, USA
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Javierre-Petit C, Schneider JA, Kapasi A, Makkinejad N, Tamhane AA, Leurgans SE, Mehta RI, Barnes LL, Bennett DA, Arfanakis K. Neuropathologic and Cognitive Correlates of Enlarged Perivascular Spaces in a Community-Based Cohort of Older Adults. Stroke 2020; 51:2825-2833. [PMID: 32757750 PMCID: PMC7484322 DOI: 10.1161/strokeaha.120.029388] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Enlarged perivascular spaces (EPVS) have been associated with aging, increased stroke risk, decreased cognitive function, and vascular dementia. However, the relationship of EPVS with age-related neuropathologies is not well understood. Therefore, the purpose of this study was to assess the neuropathologic correlates of EPVS in a large community-based cohort of older adults. The cognitive correlates of EPVS over and beyond those of other pathologies were also assessed. METHODS This study included 654 older deceased and autopsied participants of 3 longitudinal community-based studies of aging that had available data on cognition, ex vivo brain magnetic resonance imaging, and detailed neuropathologic examination. EPVS seen on ex vivo magnetic resonance imaging were histologically validated. Experienced observers rated EPVS burden in ex vivo magnetic resonance imaging using a semiquantitative 4-level scale. Elastic-net regularized ordinal logistic regression was used to investigate associations of EPVS burden with age-related neuropathologies. Mixed-effects models of cognition controlling for neuropathologies, demographics, and clinical factors, were used to determine whether EPVS burden has additional contributions to cognitive decline. RESULTS EPVS burden in the whole group was associated with gross infarcts (odds ratio=1.67, P=0.0017) and diabetes mellitus (odds ratio=1.73, P=0.004). When considering only nondemented participants (with mild or no cognitive impairment), EPVS burden was associated with gross infarcts (odds ratio=1.74, P=0.016) and microscopic infarcts (odds ratio=1.79, P=0.013). EPVS burden was associated with faster decline in visuospatial abilities (estimate=-0.009, P=0.028), in the whole group, as well as lower levels of semantic memory (estimate=-0.13, P=0.048) and visuospatial abilities (estimate=-0.11, P=0.016) at the time of death. CONCLUSIONS EPVS and infarcts may share similar neurobiological pathways regardless of dementia status. EPVS burden is linked to diabetes mellitus independently of neuropathologies, extending recent findings in animal studies implicating diabetes mellitus in impairment of the glymphatic system. Finally, EPVS burden may reflect additional brain tissue injury that may contribute to cognitive decline, not captured with traditional neuropathologic measures.
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Affiliation(s)
- Carles Javierre-Petit
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago (C.J.P., N.M., K.A.)
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL (J.A.S., A.K., A.A.T., S.E.L., R.I.M., L.L.B., D.A.B., K.A.)
| | - Alifiya Kapasi
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL (J.A.S., A.K., A.A.T., S.E.L., R.I.M., L.L.B., D.A.B., K.A.)
| | - Nazanin Makkinejad
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago (C.J.P., N.M., K.A.)
| | - Ashish A Tamhane
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL (J.A.S., A.K., A.A.T., S.E.L., R.I.M., L.L.B., D.A.B., K.A.)
| | - Sue E Leurgans
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL (J.A.S., A.K., A.A.T., S.E.L., R.I.M., L.L.B., D.A.B., K.A.)
| | - Rupal I Mehta
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL (J.A.S., A.K., A.A.T., S.E.L., R.I.M., L.L.B., D.A.B., K.A.)
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL (J.A.S., A.K., A.A.T., S.E.L., R.I.M., L.L.B., D.A.B., K.A.)
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL (J.A.S., A.K., A.A.T., S.E.L., R.I.M., L.L.B., D.A.B., K.A.)
| | - Konstantinos Arfanakis
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago (C.J.P., N.M., K.A.).,Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL (J.A.S., A.K., A.A.T., S.E.L., R.I.M., L.L.B., D.A.B., K.A.)
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Angiopatia amiloide cerebrale sporadica. Neurologia 2020. [DOI: 10.1016/s1634-7072(20)44005-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Affiliation(s)
- Thomas Raphael Meinel
- Department of Neurology (T.R.M., U.F.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Institute of Diagnostic, Interventional and Pediatric Radiology and Department of Neurology (J.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology (L.R.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Urs Fischer
- Department of Neurology (T.R.M., U.F.), Inselspital, Bern University Hospital, University of Bern, Switzerland
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Fazlollahi A, Raniga P, Bourgeat P, Yates P, Bush AI, Salvado O, Ayton S. Restricted Effect of Cerebral Microbleeds on Regional Magnetic Susceptibility. J Alzheimers Dis 2020; 76:571-577. [DOI: 10.3233/jad-200076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | - Paul Yates
- Department of Aged Care, Austin Health, Heidelberg, Victoria, Australia
| | - Ashley I. Bush
- University of Melbourne, Parkville, Victoria, Australia
- Melbourne Dementia Research Centre, Parkville, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | | | - Scott Ayton
- University of Melbourne, Parkville, Victoria, Australia
- Melbourne Dementia Research Centre, Parkville, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
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Rizk T, Turtzo LC, Cota M, Van Der Merwe AJ, Latour L, Whiting MD, Chan L. Traumatic microbleeds persist for up to five years following traumatic brain injury despite resolution of other acute findings on MRI. Brain Inj 2020; 34:773-781. [PMID: 32228304 DOI: 10.1080/02699052.2020.1725835] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The primary objective of this study was to track the incidence and progression of traumatic microbleeds (TMBs) for up to five years following traumatic brain injury (TBI). METHODS Thirty patients with mild, moderate, or severe TBI received initial MRI within 48 h of injury and continued in a longitudinal study for up to five years. The incidence and progression of MRI findings was assessed across the five year period. In addition to TMBs, we noted the presence of other imaging findings including diffusion weighted imaging (DWI) lesions, extra-axial and intraventricular hemorrhage, hematoma, traumatic meningeal enhancement (TME), fluid-attenuated inversion recovery (FLAIR) hyperintensities, and encephalomalacia. RESULTS TMBs were observed in 60% of patients at initial presentation. At one-year follow-up, TMBs were more persistent than other neuroimaging findings, with 83% remaining visible on MRI. In patients receiving serial MRI 2-5 years post-injury, acute TMBs were visible on all follow-up scans. In contrast, most other imaging markers of TBI had either resolved or evolved into ambiguous abnormalities on imaging by one year post-injury. CONCLUSIONS These findings suggest that TMBs may serve as a uniquely persistent indicator of TBI and reinforce the importance of acute post-injury imaging for accurate characterization of persistent imaging findings.
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Affiliation(s)
- Theresa Rizk
- Department of Rehabilitation Medicine, National Institutes of Health Clinical Center , Bethesda, MD, USA
| | - L Christine Turtzo
- National Institutes of Neurological Disorders and Stroke, National Institutes of Health , Bethesda, MD, USA
| | - Martin Cota
- Center for Neuroscience and Regenerative Medicine , Rockville, MD, USA
| | | | - Lawrence Latour
- National Institutes of Neurological Disorders and Stroke, National Institutes of Health , Bethesda, MD, USA.,Center for Neuroscience and Regenerative Medicine , Rockville, MD, USA
| | - Mark D Whiting
- Center for Neuroscience and Regenerative Medicine , Rockville, MD, USA
| | - Leighton Chan
- Department of Rehabilitation Medicine, National Institutes of Health Clinical Center , Bethesda, MD, USA.,Center for Neuroscience and Regenerative Medicine , Rockville, MD, USA
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da Veiga MGA, Marecos C, Vieira JP, Conceição C. Leigh Syndrome with atypical cerebellum imaging features. eNeurologicalSci 2020; 18:100214. [PMID: 32123758 PMCID: PMC7037537 DOI: 10.1016/j.ensci.2019.100214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 11/18/2019] [Indexed: 12/01/2022] Open
Affiliation(s)
- Marcos Gil Alberto da Veiga
- Department of Neuroradiology, Centro Hospitalar de Lisboa Central, 1150–199 Lisboa, Portugal
- Corresponding author at: Centro Hospitalar de Lisboa Central, Department of Neuroradiology, R. José António Serrano, 1150–199 Lisboa, Portugal.
| | - Clara Marecos
- Department of Neuropediatrics, Hospital Dona Estefânia – Centro Hospitalar de Lisboa Central, 1169–045 Lisboa, Portugal
- Department of Pediatrics, Hospital Professor Doutor Fernando Fonseca, EPE, IC19, 2720–276 Amadora, Portugal
| | - José Pedro Vieira
- Department of Neuropediatrics, Hospital Dona Estefânia – Centro Hospitalar de Lisboa Central, 1169–045 Lisboa, Portugal
| | - Carla Conceição
- Department of Neuroradiology, Centro Hospitalar de Lisboa Central, 1150–199 Lisboa, Portugal
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Hatada Y, Hashimoto M, Shiraishi S, Ishikawa T, Fukuhara R, Yuki S, Tanaka H, Miyagawa Y, Kitajima M, Uetani H, Tsunoda N, Koyama A, Ikeda M. Cerebral Microbleeds Are Associated with Cerebral Hypoperfusion in Patients with Alzheimer’s Disease. J Alzheimers Dis 2019; 71:273-280. [DOI: 10.3233/jad-190272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Yutaka Hatada
- Department of Psychiatry, Heisei Hospital, Yatsushiro, Kumamoto, Japan
| | - Mamoru Hashimoto
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Shinya Shiraishi
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomohisa Ishikawa
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Ryuji Fukuhara
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Seiji Yuki
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Hibiki Tanaka
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Yusuke Miyagawa
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Mika Kitajima
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroyuki Uetani
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Naoko Tsunoda
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Asuka Koyama
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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