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2015 ; 17
(2
): 111-22
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Prevention and Management of Cerebral Small Vessel Disease
#MMPMID26060798
Mok V
; Kim JS
J Stroke
2015[May]; 17
(2
): 111-22
PMID26060798
show ga
Lacunar infarcts/lacunes, white matter hyperintensities (WMH), and cerebral
microbleeds (CMBs) are considered various manifestations of cerebral small vessel
disease (SVD). Since the exact mechanisms of these manifestations differ, their
associated risk factors differ. High blood pressure is the most consistent risk
factor for all of these manifestations. However, a "J curve" phenomenon in terms
of blood pressure probably exists for WMH. The association between cholesterol
levels and lacunar infarcts/lacunes or WMH was less consistent and sometimes
conflicting; a low cholesterol level probably increases the risk of CMBs.
Homocysteinemia appears to be associated with WMH. It is noteworthy that the risk
factors profile may also differ between different lacunar patterns and CMBs
located at different parts of the brain. Thrombolysis, antihypertensives, and
statins are used to treat patients with symptomatic lacunar infarction, just as
in those with other stroke subtypes. However, it should be remembered that
bleeding risks increase in patients with extensive WMH and CMBs after
thrombolysis therapy. According to the Secondary Prevention of Small Subcortical
Strokes trial results, a blood pressure reduction to <130 mmHg is recommended in
patients with symptomatic lacunar infarction. However, an excessive blood
pressure decrease may induce cognitive decline in older patients with extensive
WMH. Dual antiplatelet therapy (aspirin plus clopidogrel) should be avoided
because of the excessive risk of intracerebral hemorrhage. Although no particular
antiplatelet is recommended, drugs such as cilostazol or triflusal may have
advantages for patients with SVD since they are associated with less frequent
bleeding complications than aspirin.