About subcortical ischemic vascular disease

What is subcortical ischemic vascular disease?

Binswanger disease is a progressive neurological disorder caused by arteriosclerosis and thromboembolism affecting the blood vessels that supply the white-matter and deep structures of the brain (basal ganglia and thalamus). Most patients experience progressive loss of memory and intellectual abilities (dementia), urinary urgency or incontinence, and an abnormally slow, shuffling, unsteady pattern of walking, usually over a 5-10 year period. Due to their vascular etiology, the symptoms and physical findings associated with Binswanger disease may suddenly worsen due to stroke, stabilize and then improve for a brief time, but the patient's overall condition continues to progress as the blood vessels become increasingly obstructed.

What are the symptoms for subcortical ischemic vascular disease?

Microvascular ischemic disease can be mild, moderate, or severe.

Many older adults — especially those with a mild form of the disease — have no symptoms, even though there are areas of damage in the brain. This is called “silent” disease. In one study, up to 20 percent of healthy elderly people had silent damage in their brain, most of which was caused by small vessel disease.

Even though you might not notice any symptoms, you may have subtle changes in your thinking and physical abilities.

More severe small vessel disease can cause symptoms like these:

  • loss of thinking skills (cognitive impairment)
  • problems with walking and balance
  • depression

If small vessel disease causes a stroke, symptoms can include:

  • Numbness or weakness, especially on one side of the body
  • sudden confusion
  • Trouble speaking or understanding
  • Vision loss in one or both eyes
  • dizziness
  • loss of balance or coordination
  • sudden, severe headache

A stroke is a medical emergency that needs to be treated right away.

What are the causes for subcortical ischemic vascular disease?

The cause of microvascular ischemic disease isn’t completely understood. It can be the result of plaque buildup and hardening (atherosclerosis) that damages the small blood vessels nourishing the brain. This is the same process that narrows and damages blood vessels to the heart and can lead to heart attacks.

Damage can block blood flow through the blood vessels in the brain, depriving brain cells (neurons) of oxygen. Or, it can cause blood vessels in the brain to leak and bleed, which can damage neighboring neurons.

What are the treatments for subcortical ischemic vascular disease?

Treatment generally involves managing the risk factors that contribute to small blood vessel damage in the brain. Which treatment strategy your doctor recommends will depend on your specific risk factors, but it might include:

  • Lowering your blood pressure with diet, exercise, weight loss, and medication. The goal for people age 60 and over is a systolic blood pressure (the top number) below 150.
  • Lowering your cholesterol level with diet, exercise, and statin drugs if needed.
  • Taking B vitamins to lower homocysteine levels. Homocysteine is an amino acid that at high levels has been linked to atherosclerosis and blood clots.
  • Taking aspirin or blood thinning drugs to prevent strokes.
  • Quitting smoking.

What are the risk factors for subcortical ischemic vascular disease?

Risk factors for microvascular ischemic disease include:

  • high blood pressure
  • high cholesterol
  • aging
  • smoking
  • diabetes
  • hardened arteries
  • atrial fibrillation

Is there a cure/medications for subcortical ischemic vascular disease?

Ischemic small-vessel disease can be very serious, leading to stroke, dementia, and death if it isn’t treated. It causes about 45 percent of dementia cases and 20 percent of strokes.

The best way to avoid these complications is to prevent small blood vessel damage in the first place. Follow a healthy diet, exercise regularly, and take the medication your doctor recommends to control your blood pressure and cholesterol levels.

Video related to subcortical ischemic vascular disease