What is 'small vessel disease'?

Question

And, what are the long term implications of having frequent TIA's due to small vessel disease?

Answer 1

Small vessel disease speaks of problems in the smaller arteries in the brain.

The heart pumps all blood through the largest "vessel", the ascending aorta. Then, vessels or arteries break off from this vessel heading up towards the head and arms or down towards the abdomen and legs. These vessels keep splitting into smaller and smaller arteries all the way out to the fingers and toes.

Towards the head, you have the common carotids on the left and right...and then the internal/external carotids, etc...down to smaller and more dividing vessels.

A stroke or CVA is caused by a bursting artery ("hemorrhage") or an artery than suddenly gets blocked or clogged up by a blood clot ("ischemic"). When this happens, blood flow downstream to the brain goes way down. Since blood carries oxygen to the brain cells so they work properly, this means that suddenly a bunch of brain cells aren't getting the oxygen they need. They either malfunction or completely die. When this happens, the brain malfunctions, and suddenly the person can't use their arms or legs like they use to...muscles don't respond...the face sags, person can't speak, person gets confused, or something similar happens.

A TIA's is simply a transient ischemic attack. It is a "mini-stroke" in which the same thing happens in a CVA (stroke), but it is only for a brief period of time. In less than 24 hours, all function is typically back to normal in a TIA. In a CVA, there could be permanent disability or it could take years of rehabilitation to regain function.

Obviously, if a larger vessel bursts or is blocked, more of the brain is involved. Typically, a HUGE clot blocks a LOT of flow...resulting in a massive stroke with permanent disability and more problems.

When smaller vessels are involved, instead, oftentimes the experience is not as dramatic, etc. Not as much dysfunction is seen. In fact, the person may not even know or experience anything it can be so subtle. It is thought that even fluctuations in blood pressure can cause small vessel disease type TIAs, without a bursting artery or a blocked artery.

In any event, small vessel disease is fairly common as you get older. In fact, it may be mentioned incidentally on the reading of a CT scan or MRI of the head of the elderly with virtually no clinical significance.

However, frequent TIAs from small vessel disease is thought to be related to a deteriorating dementia, called "multi-infarct dementia". It is very similar to Alzheimer's, except rather than a gradual more subtle decline day-to-day, it occurs more in a stepwise fashion. With each TIA, cognitive function decreases a certain percentage...never to return. Many times, the muscles work OK, but the person is a bit more confused, has poorer memory, or just quite isn't the same after each event.

Large vessel disease is sometimes treatable with surgery, while small vessel disease is typically not. Treating underlying conditions and trying to prevent recurrence becomes key.

But I am not a neurologist, and speaking to one of them would likely lead to more and better information.

Hope this helped some...

Answer 2

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