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Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
Association of cortical microinfarcts and cerebral small vessel pathology in the ageing brain
E Kövari1, F R Herrmann2, G Gold2
1Department of Mental Health and Psychiatry, University Hospitals and University of Geneva, Geneva, Switzerland.
Aims:
Cortical microinfarcts (CMI) are frequently observed in the ageing brain independent of cognitive decline, but their aetiology is not fully elucidated. To examine the potential role of different vessel pathologies, including cerebral amyloid angiopathy (CAA), arteriolosclerosis-hyalinosis and thromboembolism in the development of CMI, we examined 80 autopsy cases with more than one CMI on routine neuropathological examination.
Methods:
Pial and intracortical vessels around CMI were assessed for their integrity with haematoxylin-eosin staining and antibodies against amyloid-β protein and fibrinogen using a semiquantitative four-level rating scale (absent to severe) in the hippocampus, and the frontal, temporal and occipital cortex. Four histological categories of changes were defined: CAA, vessel pathology other than CAA, thromboembolism and absence of vessel pathology near CMI.
Results:
A differential distribution of microvascular pathology was observed depending on brain regions. In the occipital cortex, CAA was commonly associated with CMI. In contrast, in the hippocampus and the frontal cortex, cases without any vascular pathology in pial and intracortical vessels were significantly more frequent.
Conclusions:
The aetiology of CMI differs depending on brain location. CAA may play a role principally in the occipital cortex. The large number of intact vessels around the CMI (mainly in the frontal cortex and hippocampus) raises the possibility that pathologies other than structural microangiopathy, including hypoperfusion/arterial hypotension or large vessel atherosclerosis, play a role in the development of microvascular lesions. These results are relevant in the context of aetiopathogenesis of vascular changes associated with conditions like vascular dementia.
Insights
The cause of cortical microinfarcts (CMI) varies by brain region. Cerebral amyloid angiopathy (CAA) is linked to CMI in the occipital cortex, while other factors may cause CMI in different brain areas.
Area of Science:
- Neuropathology
- Neuroscience
- Vascular Biology
Background:
- Cortical microinfarcts (CMI) are common in aging brains but their origins remain unclear.
- Investigating vessel pathologies like cerebral amyloid angiopathy (CAA) is crucial for understanding CMI aetiology.
Purpose of the Study:
- To determine the role of cerebral amyloid angiopathy (CAA), arteriolosclerosis-hyalinosis, and thromboembolism in the development of cortical microinfarcts (CMI).
- To analyze the regional distribution of microvascular pathologies associated with CMI in autopsy cases.
Main Methods:
- Examined 80 autopsy cases with multiple cortical microinfarcts (CMI).
- Assessed pial and intracortical vessels for integrity using hematoxylin-eosin and specific protein staining.
- Categorized vessel changes into CAA, non-CAA pathology, thromboembolism, or absence of pathology near CMI.
Main Results:
- Microvascular pathology distribution varied significantly across brain regions.
- Cerebral amyloid angiopathy (CAA) was frequently associated with CMI in the occipital cortex.
- CMI in the hippocampus and frontal cortex often occurred without detectable vascular pathology in surrounding vessels.
Conclusions:
- The aetiology of cortical microinfarcts (CMI) is region-dependent.
- Cerebral amyloid angiopathy (CAA) is implicated in CMI, particularly in the occipital cortex.
- Intact vessels near CMI suggest non-structural pathologies like hypoperfusion may contribute to CMI development, relevant to vascular dementia.
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