Nonhypertensive cerebral small-vessel disease. An autopsy study

Area of Science:

• Neuropathology
• Vascular Biology
• Geriatrics

Background:

• Cerebral small-vessel disease (SVD) is a common aging-related condition.
• Hypertension and diabetes mellitus exacerbate SVD, leading to lacunar infarction and hemorrhage.

Purpose of the Study:

• To determine the frequency of pathologically verified SVD without classic risk factors.
• To expand the analysis of risk factors associated with SVD.

Main Methods:

• Examined 70 autopsy brains with microscopic evidence of SVD.
• Reviewed clinical records, autopsy reports, and histology.
• Graded SVD severity in six brain regions and correlated with risk factors.

Main Results:

• SVD primarily showed concentric hyaline wall thickening; lipohyalinosis and fibrinoid necrosis were rare.
• 31% of cases lacked criteria for significant hypertension; 9% had no classic risk factors (non-elderly, non-diabetic, normotensive).
• Five of six cases without classic risk factors had conditions increasing small-vessel permeability.

Conclusions:

• Effective hypertension treatment may alter SVD presentation, leading to absent classic risk factors.
• Conditions enhancing small-vessel permeability are potential contributors to SVD pathogenesis.