Radiological pathology of ischemic microvascular brain disease…An update

Radiological pathology of ischemic microvascular brain disease…An update
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1. ill},

yee ames

nd

2. Stroke, TIAs, muli-infaret dementia, essential |
ypertension, depression, parkinsonism

Type VI hyp mia (Hypertrighycer |
hyperuricemia, type 2 diabetes,

truncal obesity (The metabolic syndrome)

ular pathology Lipohyalinosis, astrogliosis and interstitial edema, el

Increased whole blood viscosity and hypercoa
smorheological changes characteriz an increased. plasminogen activat
nhibitor-1 (PAI-D level.

3. Parkinzonlsm

depression Type I Diabetes

Tromtoyeresis

7. 000.

11. DL

23. Central and cortical This is secondary to chronic global reduction of brain perfu
atrophy

Leukoaraiosis (diffuse Leukoaraiosis is an ischaemic demyelination of the
eriventricular white periventricular white matter with axonal loss, astroglios
atter disease) rsttial edema. It is secondary to chronic global

Lacunar in a lary to the micro vascular thrombo-|
‘are most numerous in the perivents
ganglia) and the immed

Granular atrophy ular atrophy is defined pa cally as infarctions localized |
to the cerebral cortex e beortical white
matter.

Basal are calcification of the the art wall of the |
calcifications irculation within the basal gs

Dilated Virchow. Dilation of Virchow-Robin Spaces provides a potential alternative |
Robin Spaces biomarker of microw e (small vessel disease).

29. PATHOLOGY

[er SCAN

Leukoaraiosis

31. © MEDICATION

Alteplase (Activase)- TPA used in ment of acute myocardial
aretion (AMI), acute ischemic stroke, and pulmonary embolism

(PE). No other IV-administered fibrinolytic has been shown to have

clinical efficacy. A post hoc analysis showed that all stroke subty

‘Adult Dose 7, 10% given as bolus IV and

Heart Association (AHA) guidelines:
3h of stroke onset (or when last well) 2) CT scan evidence
recent jor infaret
(with prolonged aPTT or PT greater!
an or INR greater than
ls) count <100,000/
[Documented hype + another stroke or major h
n last 3 mo; major su -atment systolic BP

>185 mm Hg or diastolic BP >110 mm Hg: rapidly improving sig
[mila deficit; pr

st 21 di recent myoc

that alter platelet funetio
elopidogrel) and anticoagulants may

let agents
because of risk of

IF puncture sites, wi
of vitamin K antagonists; control and monitor:

pressure frequently during and following alteplase
managing acute ischemic stroke); do not use

e Ischemic stroke; doses >0.9 mg/kg may

Precautions

32. Drug Name

‘Adult Dose

Interactions

Aspiri
nelude ticlopidine and clopidogre
aspi

alone.

(Anacin, Ascriptin, Bayer Aspirin)- Alternatives to asp)
. These drugs and combination of
y superior to aspiri

oa

with u

antacids
salicylate

urinary” alkalinizers;
levels:

decrease with
decrease

Effects may

[corticosteroids serun

ects of proben:
; doses greater than 2 gi
fonylurea drugs.

polyps; may cause transient decrease
wate chronic kidney disease; avoid use in patients
vit severe anemia, with history of blood coagulation defects, or

taking anticoagulants

Drug Name

Adult Dose
Pediatric Dose

‘Contraindications

Lock)- Can be used in conjunction with compression!

stockings. Augments activity of antithrombi
on of fibrinoge Does not lyse)
further Prevents

Heparin (i
Istockings or pneum:
It and prevents conver
actively "but can inhibit
reaccumulation of lot after spontaneous
[Emo USC bid

[Not established

[Docu bacterial endocarditis, active

bleed

NSAIDs,

effects; aspirin,

33. In neonates, preservative-tree hepari ded to avoid
[possible toxicity (gasping syndrome) by benzyl alcohol, which is used
las preservative; caution in severe hypotension and shock

Drug Name

‘Adult Dose,

tions

The recently published Heart Outcomes Prevention
Evaluation (HOPE) study showed the benefit of ramipril in patients
lwith vascular disease and diabetics with vascular risk factors. It
Iknown whether this isa lass effect

digoxin, and allopurinol
[probenecid may increase ramipril levels; coadminist
ldiuretics, increase hypotensive effects; the hypotensiv