Small vessel disease and atrophy of the brain. A neurologist explains. How to protect your brain?
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- เผยแพร่เมื่อ 25 มิ.ย. 2024
- The natural aging process is the most common cause of mild "non-specific white spots" (non-specific white matter disease) on an MRI scan. It can also be caused by small vessel disease, which is also known as subcortical white matter disease, chronic ischemic microvascular changes, chronic microangiopathic changes, or white matter hyperintensities (leukoaraiosis).
What is the white matter?
The white matter is a part of the brain that consists of bundles of nerve fibers. These fibers are typically white or near-white in color due to the layer that covers them. Within these areas of the brain, there are small and delicate vessels that can easily become blocked or damaged, resulting in a white appearance on an MRI (T2/FLAIR) or a darker appearance on a CT scan. This leads to a decrease in blood supply, which is not ideal as severe acute deficiencies can cause permanent cell death, known as infarction of the brain. This is commonly referred clinically to as an ischemic stroke due to small vessel disease. In less severe cases, usually with slow progression, it may lead to dementia (vascular dementia), walking or balance issues, apathy, depression, sleep disturbances, urinary symptoms, and technically, parkinsonism, even though there is some controversy about “pure” vascular parkinsonism.
*Most common risk factors for the MRI "white spots" in your brain:
High blood pressure, diabetes, high "bad cholesterol", obesity. Just to give you an idea, the obesity prevalence in the US was 41.9 % in 2017.
www.cdc.gov/obesity/data/adul...
Smoking
Head trauma
Migraine??
Some less common disorders can affect the brain's white matter. These include but are not limited to autoimmune diseases like multiple sclerosis, which can display varying patterns, locations, and morphology. Additionally, a past brain infection may lead to white matter disease, as can rare genetic disorders.
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Read “My Cholesterol Guide” by AHA. The link is in the description of this video.
www.heart.org/-/media/Files/H...
Dr. Z
I am a board-certified internist and neurologist certified by the American Board of Internal Medicine and the American Board of Psychiatry and Neurology. I completed a fellowship in Movement Disorders and Neuro Critical Care. Prior to attending medical school, I worked as a physical therapist for three years (Former NJ and PR licensed physical therapist).
True frustration is suddenly becoming fully incontinent at 36, suddenly developing focal aware seizures, as well as tingling, raynauds and neuropathy in my extremities, and severe cognitive decline among other things and being told the white spots and atrophy are just normal aging. At 36. With all the sudden onset of symptoms not taken into consideration. I am having a spine MRI in a month. Pray that this will finally get me somewhere. Ive been fighting to be heard and not told "youre just getting old" for three years now. Im only 39.
What a find! I had a lacunar stroke 2.5 months ago. 69 yrs., Normal wt., never smoked, lifelong fitness advocate, vegetarian. Lower Left side is numb. Getting good rehab and am working hard to walk normally. But I can’t see a neuro for 8.5 months 😢. Your video is a miracle, a gift.
I also had a thalamic lancular stroke!
8mths on my balance is completely off and I have heavy feeling in the left arm and leg!
Weirdly I also struggled getting words out although that settled down but I feel like I don't physically recognise who I am right now!
Was told I should be almost recovered by now but that's a long way off!
I'm 61yrs old never smoked and was very healthy prior to this stroke!
Very informative doctor glad I found you and your video. I’m so sick and tired of hearing from the MRIs and CAT scans about the white matter etc. etc. it always appears to me that these doctors are too lazy to order other tests and check for further problems if you’re someone like me who has kidney disease Liver disease, diabetes high HDL triglycerides are used to be about 13.9 on the A1c and I’m now down to around 10. It’s still explosive pressure in your system. I see my doctors in Boston on Tuesday. I currently have skin cancer along with other issues and I am going to request a pet scan, so I can find out more clearly where the cancer cells may be seeing as my father died of pancreatic cancer at 68 and I am 64. My mother had a stroke has a fib she’s 87 and my brother who is 65 had a stroke at 62 my grandfather died of a heart attack at 58 years old, his wife, my grandmother on my father side again died of an aneurysm and stroke. I’m not gonna wait around to be the next one. I’ve been very proactive and I’ve got to put them up against the wall and smack them around for a while until they get the message, cause some of these doctors need a good tuneup pardon my expression thank you for the knowledge that you shared and helps people such as myself to be able to continue to run my own healthcare
Thank you for offering this valuable information. It would have helped me immensely on what to expect if i knew about SVD 11 years ago when my dad's cognitive decline began. It was relatively abrupt. In less than a month he descended into a hazy and depressed state of mind, compared to his previous diligent and brilliant personality. Both MRI and CT reported: "Old lacunar infarct in the region of the left lentiform nuclei" and "periventricular and subcortical bifrontal FLAIR hyperintensities". Years later I learn about SVD, and the functions exerted by the areas of the brain where the lacunar infarction and the hyperintensities appeared (under the basal ganglia, white matter around the ventricles and the basal forebrain), also about the clinical consequences when the circuits in those areas are interrupted.
That explained his long progressive but stepped decline, sudden dementia, depression, obsession with certain foods, apathy, incontinence, poor balance, frequent falls, etc. The neurologist diagnosed AD because of the mild atrophy in the hippocampus shown on the MRI, also because he failed miserably on cognitive tests. but I felt it was something else. Maybe he have both AD and SVD but now it doesn't matter. In the final stages of any dementia they all look the same. My dad's is too severe now and it's too late to do something about it.
That is right. The majority of the patients have a combined process. We are more predisposed to that since we are living longer. The diagnosis of Alzheimer's disease is more accurate clinically at this time due to multiple biomarkers available, including findings on the cerebral spinal fluid. However, the combined process is the rule rather than the exception. A good diet and high-mod intensity exercises are paramount. People need to start now, not later.
I was diagnosed at the age 44 with small vessel disease chronic
Thank you for the info
My dad passed away in 1991 due to cerebral atrophy at the age of 69. His symptoms appeared about 2 years before he passed away.
1) he lost his memory gradually
2) he lost ability to walk.
Sorry pad, what did he die from?
Same happened to my mum. she passed on 21st may, 2024 at 65. dementia happened 2 years 2 months before she passed.
First memory loss, hyper agitation, lost ability to walk and keep balance, ability to swallow, finally couldn't breathe...
I think there could be a genetic link on why this can happen and also autoimmune implications are being studied right now!
I've had a small thalamic infarct stroke that i was told might be due to high blood pressure!
I also have what they called small vessel disease with mild white matter
I read a lot and found a lot of information on how it can cause cognitive decline and dementia..im hoping that I'm not going in that direction!
Your video was spot on describing what you can possibly do to prevent it..although there is a lot of clinical trials looking into inflammation and autoimmune causes for people that have healthy lifestyles but still develop white matter lesions and infarcts at a young age!
My so called small infarct stroke has left me with severe balance issues and weakness in the lower left leg and that's after 8mths and physio
These small infarcts have a tendency to be called strokes that have a good recovery..but in my case and many others that hasn't happened!
Great content
Thank you for sharing
Thanks a lot docter very informative
Thanks Doctor!
I have T2 white spots on my brain MRI also. I had taken pseudoephedrine and did not realize that it stimulates TRPV1 that constricts microvessels called arterioles. This leads to cerebral ischemia due to too much vascular constriction that does not allow enough oxygenated blood to the brain. I had dropped foot and weak left side of my body. I took vitamin D 10,000 i.u. 4 X/day and it stopped. Vitamin D is a partial agonist of TRPV1 and blocks complete agonists such as pseudoephedrine and capsaicin in hot peppers and other things such as acidic pH and heat. I stopped taking pseudoephedrine after realized what had happened.
I'm curious about your situation. I took ephedrine consistently for about 8 years, and now I'm wondering if I'm seeing the same thing. My MRI is showing an impression of small vessel disease. If you have any more insight as to the condition I can consider that would be helpful.
Thanks,
@@dlambethful I haven’t looked further since my lesions have not changed in 3 years. There are a number of reasons for them and my basic impression is that the keto, low carb and carnivore diets are the best at not adding inflammation to the microvasculature in addition to holding off the ephedrine type drugs. Multiple sclerosis patients get brain lesions due to destruction of the myelin that surrounds the neurons and TRPA1 has been found to cause that. TRPA1 is a transient receptor potential channel that is stimulated by many things from inflammation to foods such as mustard oil, garlic, cinnamon, toxins and cold temperatures.
Ty! ❤️ capsaicin protects against ischaemic or excitotoxic cerebral neuronal injury and may lower the risk of cerebral stroke.
-pubmed
@@Tad-zh4wr capsaicin does however it can cause cardiac death too in people who take it for weight loss. Too much capsaicin also stimulates too much TRPV1 that leads to hyponatremia, bone loss and many other health problems such as the hypoosmolality ->too much TRPV4-> hypokalemia and induces Brugada syndrome sudden cardiac death. Combined with the carbohydrate/sugar stimulation of glp-1 can stimulate too much GnRH -> FSH -> SHBG and in people with low estrogen cause many disease from very little active estrogen osteoporosis, hearing/vestibular loss of function, neuropathy such as small fiber neuropathy/pain, atherosclerosis, hypertension.
Thank you very much for this presentation! I am in my early 70’s and have several of the factors you spoke about. I’ve been seeing a neurologist. This information was helpful!
What treatment did you get
Old age just snuck up on me. Doesn’t God have a good sense of humor. We look like cartoon characters lol🙏🏻
thank you, I am terrified no one explained any of this to me . I am not old but my scan you wouldnt guess
I'm 38 and my MRI shows white matter and small vessel ischemic disease...and the lesions look like mini strokes?? Wth I've never had a stroke...but my mother has??I forget everything...it's frustrating when your brain doesn't work...
What details it says in mri? I have confluent bilateral periventricular white matter that are hyper intense
May be ok. We are all allowed one or 2 whl each decade. How is your cardiovascular health? Pls eat good cholesterol and do cardio bc it helps w good blood flow !
Pubmed is a good source for your medical research
my mom's brain scan report showed - cerebral atrophy, widened sulci. last stages of dementia she lost limb movement, speech, couldn't swallow...
I am sorry that you did not discuss links with autoimmune diseases.
That is right, but the lesions tend to have different characteristics. Also, it is significantly less common. For example, MS is an autoimmune disease with characteristic lesions and many other clinical features.
@@luisezayasmdpt4397 I would love you to be able to take a look at my brain scans, they ruled out MS and susac syndrome and then said looks like small blood vessel disease but the whole brain lights up and I have had so many DRs say well you certainly don’t look like someone who has all that wrong and been told they haven’t seen anything like it before, for someone to have so many random widespread diseases across the body and look fine on the outside, am 39 and have also had a lot of gaslighting because I have a immunodeficiency aswell and my bloods don’t show infections, inflammation or damage
how is CKD related to dementia?
ANYBODY TAKING MEDICATION FOR THIS CONDITION????
Hi My mom has csvd in brain my mom only 41 years old she didn’t smoke she didn’t drink but for 6 years she has been having bad headache yesterday She was taken MRI and doctor said she has this disease WHAT CAN I DO
Do you do online consultations ? I am in the U.K.
No. Only in Tennessee, USA. Face to face.
I am in SD and want to find a board certified neurologist that will take white matter seriously and prevent further and improve rather than ignore. How to find a gd neurologist, I have options with a PPO
I was just diagnosed with cerebral small vessel disease. Unfortunately, I don't have any risk factors to work on other than age.
Take care
Unfortunately, or fortunately?
test for toxoplasmosis
I read on pubmed people are all allowed one or 2 whl each decade.
This is me and I'm terrified
I get you completely I actually am terrified of developing dementia as I had a thalamic stroke and they say the recovery is good for these strokes but 8mths on I have no balance and a heavy left leg!
Let's just hope we don't go up the dementia route until we are in our 80s😂
@@margareteid3164fearful, had a tbi n this is now a concern
Try to find info about how it’s normal to have 1-2 legions per decade
Question - what about COVID/Long Covid effects on small vessels in the brain?
I don’t think anybody knows. There are many things from Covid 19 still unclear
@@luisezayasmdpt4397 Yes, thank you, I guess then that there are only hypotheses & some limited studies, nothing very definitive.
I am 51and was told I have small vessel disease. I have atherosclerosis in my brain I feel I am too young and it scares me
And I have had seven strokes
I’m have it too I’m only 43yr
Old my mri show few white spots
I have aswell I am 39 and brain lights up like a Christmas tree with it they said, rare apparently at our age and had strokes too and a lot of internal damage widespread
@@familyvlogsellieneavejackb3251are you taking any medicine and what are your symptoms
I had a concussion last year, had an mri scan this year which showed mild CVD, I've had continuous head pain, dizziness, pressure feeling since concussion, though my neurologist says the CVD is not due to the concussion, I know it is.
Get good sleep.
Get one of those pulseox meters you can wear while you sleep and records to your cellphone.
Discuss bad sleep with specialist
Sleep apnea is one of the risk factors. Get this: I got a fitted dental guard on upper and it stopped my snoring bc I can’t suck air thru mouth when it’s on so I’m forced to use my nose. I use Vaseline keep moist. But yeah, I’ll never use that other apnea device that thrust jaw forward bc it moves the teeth.
It is not normal. I am doomed. I take lion maine, b12, b5,b1 and other supplements nothing works.
ME49 toxoplasmosis in the JABS didn't help..
ROSUVASTATIN if you want a statin..
research toxoplasmosis because that's what all those MEDS are FOR
we want to get RID of TOXO not keep it at bay for another day to reactivate...
MODERN day SNAKE OIL salesmen now use bacteria, fungi, mold, PARASITES and WORMS!