The Relationship of Cerebral Vessel Pathology to Brain Microinfarcts

Abstract

The relationship of cerebral vessel pathology to brain microinfarcts is not fully understood. We examined associations of cerebral vessel pathology with microinfarcts among community-dwelling persons who came to autopsy. Brain specimens were derived from 1,066 deceased subjects (mean age-at-death = 88 years, 65% women) participating in a cohort study of aging. Microinfarcts were classified by number, age and location. Severity of vessel pathologies was graded semi-quantitatively. Almost a third of subjects (n = 300; 28%) had at least one chronic microinfarct, including 128 cortical only, 120 subcortical only, and 47 with both. Moderate-to-severe atherosclerosis was present in 430 (41%) subjects, arteriolosclerosis in 382 (36%), and amyloid angiopathy in 374 (35%). The odds of one or multiple microinfarct(s) was increased for more severe atherosclerosis (OR =1.22; 95%CI: 1.03-1.45), arteriolosclerosis (OR =1.18; 95%CI: 1.02-1.37) and amyloid angiopathy (OR =1.13; 95%CI: 1.00-1.28). Separately, the odds of subcortical microinfarct(s) was increased for atherosclerosis (OR =1.49; 95%CI: 1.20-1.84) and arteriolosclerosis (OR =1.39; 95%CI: 1.16-1.67) but not amyloid angiopathy; whereas the odds of cortical microinfarct(s) was increased for amyloid angiopathy (OR =1.26; 95%CI: 1.09-1.46) only. While cerebral vessel pathologies are associated with microinfarct burden, atherosclerosis and arteriolosclerosis are associated with subcortical microinfarcts, and amyloid angiopathy with cortical microinfarcts.

Keywords: atherosclerosis; brain; cerebrovascular disease; epidemiology; infarction; pathology.

Figure 1

Number of subjects with no, one, two, or three cerebral vessel pathology(ies), with and without Microinfarcts.

Figure 2

Distribution of cerebral vessel pathology by cortical and subcortical microinfarcts. Legend: Each panel shows % of subjects by level of vessel pathology severity (left most column: atherosclerosis, middle column: arteriolosclerosis, right most column: amyloid angiopathy) and burden of cortical (bottom row) or subcortical microinfarcts (top row). Light green represents multiple microinfarcts in the given location, and dark green represents a single microinfarct, and white represents no microinfarcts. Note the shift toward an increased burden of subcortical microinfarcts with increased atherosclerosis and arteriolosclerosis severity (top left and top middle panels), and shift toward an increased burden of cortical microinfarcts with increased amyloid angiopathy severity (bottom right panel).