Microvascular Pathology

Kalaria, RN; Attems, J

doi:10.1016/B978-0-12-385157-4.00594-7

Microvascular Pathology

Lookup NU author(s): Professor Raj Kalaria ORCiD, Professor Johannes Attems

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Abstract

© 2014 Elsevier Inc. All rights reserved. With increasing age, large strategic cortical lesions become rarer but lacunar infarcts and multiple microinfarcts occur frequently (>50%). These latter are predominantly caused by intracranial small vessel disease (SVD), which comprises variable degrees of microvascular pathology. This may involve focal aggregates of protein deposition, cerebral amyloid angiopathy, arteriolosclerosis, collagenosis, microatheroma, and microaneurysms. Familial disorders such as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, the most common cause of strokes, are characterized by severe SVD leading to arteriopathy and disintegration of the brain endothelium and parenchymal changes including subcortical infarcts, diffuse white matter changes, and neuronal atrophy. Microvascular pathology causes a chronic hypoxic state generated by reduced perfusion.