Cerebral microangiopathy in the mosaic of new discoveries.
After a short historical note on the diversion of the vascular concept of dementia from that of primary degeneration, this review describes cerebral deterioration on vascular grounds in three levels. Occlusions of big vessels with a single major infarct, middle calibre vasculopathy with multiple lacunes and finally microangiopathy causing leukoaraiosis--all these three entities produce cognitive disorders. Changes in the vessel wall, in cerebral blood flow velocity, the territorial and interterritorial rules for the location of malacia or lacunes are reviewed using neuroradiologic aspects revealed by ultrasound, by CT and MRI. Alterations in diffusion and their measurements by MRI are discussed in regard to ultrastructural reactions to ischaemia. Thresholds for tissue deterioration are shown in association with ATP depletion and with pathologic compounds in the interstitium.
Kalvach
Pavel
P
Department of Neurology, Charles University, 3rd Medical Faculty, FNKV, Srobárova 50, 100 00 Prague 10, Czech Republic.
Gregová
Daniela
D
D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis / Q000473:pathology; D001284:Atrophy; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000473:pathology; D015140:Dementia, Vascular / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D006624:Hippocampus / Q000473:pathology; D006801:Humans