Clinical symptoms and risk factors in cerebral microangiopathy patients

Abstract

Objective: Although the clinical manifestation and risk factors of cerebral microangiopathy (CM) remain unclear, the number of diagnoses is increasing. Hence, patterns of association among lesion topography and severity, clinical symptoms and demographic and disease risk factors were investigated retrospectively in a cohort of CM patients.

Methods: Patients treated at the Department of Neurology, University of Bonn for CM (n = 223; 98m, 125f; aged 77.32±9.09) from 2005 to 2010 were retrospectively enrolled. Clinical symptoms, blood chemistry, potential risk factors, demographic data and ratings of vascular pathology in the brain based on the Wahlund scale were analyzed using Pearson's chi square test and one-way ANOVA.

Results: Progressive cognitive decline (38.1%), gait apraxia (27.8%), stroke-related symptoms and seizures (24.2%), TIA-symptoms (22%) and vertigo (17%) were frequent symptoms within the study population. Frontal lobe WMLs/lacunar infarcts led to more frequent presentation of progressive cognitive decline, seizures, gait apraxia, stroke-related symptoms, TIA, vertigo and incontinence. Parietooccipital WMLs/lacunar infarcts were related to higher frequencies of TIA, seizures and incontinence. Basal ganglia WMLs/lacunar infarcts were seen in patients with more complaints of gait apraxia, vertigo and incontinence. Age (p = .012), arterial hypertension (p<.000), obesity (p<.000) and cerebral macroangiopathy (p = .018) were positively related to cerebral lesion load. For increased glucose level, homocysteine, CRP and D-Dimers there was no association.

Conclusion: This underlines the association of CM with neurological symptoms upon admission in a topographical manner. Seizures and vertigo are symptoms of CM which may have been missed in previous studies. In addition to confirming known risk factors such as aging and arterial hypertension, obesity appears to increase the risk as well. Since the incidence of CM is increasing, future studies should focus on the importance of prevention of vascular risk factors on its pathogenesis.

Figure 1. Neurological symptoms at admittance.

The symptoms at admittance are described as (A) total prevalence in study population (n = 223) and (B) their relative frequency according to gender (M  =  male, F  =  female). The symptoms could co-occur in patients and are therefore not mutually exclusive. After correcting for the greater number of female subjects included, all symptoms were equally distributed across genders. (C) Equivalent distribution of white matter lesion severity across genders. (D) Age influences the severity-grading of WML/lacunar infarcts. Mean age of patients was 77.32±9.09 years. The highest prevalence of WML/lacunar infarcts was found in patients 75–85 years of age, representing 42% of the entire study population. There was an age effect on lesion severity (described by Wahlund, et al., 2001) of CM (One-way, ANOVA, *p = .012).

Figure 2. Gender and severity-dependent occurrence of neurological symptoms at admittance.

Data from 223 patients, 98 males (M) and 125 females (F) were graded for lesion severity based on CT or MRI scans using the system described by Wahlund, et al., 2001 (Grade 1 =  focal lesions, 2 =  confluent lesions, 3 =  diffuse lesions). With the exception of progressive cognitive decline that occurred more frequently in male patients suffering from Grade 3 WML/lacunar infarcts, symptoms were about equally distributed across severity grades and gender (p = n.s., Pearson's chi square).

Figure 3. Frequency of vascular risk factors found in patients with cerebral microangiopathy.

(A) The frequencies of vascular risk factors including arterial hypertension, obesity, hypercholesteremia, cerebral macroangiopathy, heart disease and diabetes are given here as percentages of total study population and broken down by gender. (B) The frequency of vascular risk factors in across different Wahlund grades (Wahlund, et al., 2001; Grade 1 =  focal lesions, Grade 2 =  confluent lesions, Grade 3 =  diffuse lesions). Occurrence of obesity (***p<.000, Pearson's chi square test) and cerebral macroangiopathy were unevenly distributed among the severity grades of WML and lacunar infarcts (p = .018, Pearson's chi square test).