small vessel disease and MS

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

small vessel disease and MS

Postby Cece » Tue Jan 03, 2017 9:38 am

https://www.ncbi.nlm.nih.gov/pubmed/27864848
Brain Pathol. 2016 Nov 19. doi: 10.1111/bpa.12460.

Age-related small vessel disease: A potential contributor to neurodegeneration in multiple sclerosis.
Geraldes R1, Esiri MM1, DeLuca GC1, Palace J1.


Abstract
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system wherein, after an initial phase of transient neurological defects, slow neurological deterioration due to progressive neuronal loss ensues. Age is a major determinant of MS progression onset and disability. Over the past years, several mechanisms have been proposed to explain the key drivers of neurodegeneration and disability accumulation in MS. However, the effect of commonly encountered age-related cerebral vessel disease, namely small vessel disease (SVD), has been largely neglected and constitutes the aim of this review. SVD shares some features with MS, i.e. white matter demyelination and brain atrophy, and has been shown to contribute to the neuronal damage seen in vascular cognitive impairment. Several lines of evidence suggest that an interaction between MS and SVD may influence MS-related neurodegeneration. SVD may contribute to hypoperfusion, reduced vascular reactivity and tissue hypoxia, features seen in MS. Venule and endothelium abnormalities have been documented in MS but the role of arterioles and of other neurovascular unit structures, such as the pericyte, have not been explored. Vascular risk factors (VRF) have recently been associated with faster progression in MS though the mechanisms are unclear since very few studies have addressed the impact of VRF and SVD on MS imaging and pathology outcomes. Therapeutic agents targeting the microvasculature and the neurovascular unit may impact both SVD and MS and may benefit patients with dual pathology.

This was posted by Joan over at the CCSVI in MS facebook page. Great article. It mentions therapeutic agents that target the microvasculature and the neurovascular unit, what specific therapeutic agents do that? I am in favor of pharmaceutical solutions that work.
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Re: small vessel disease and MS

Postby ThisIsMA » Sat Jan 07, 2017 8:00 pm

Hi Cece,

Thanks for posting this study. I'd never heard of "small vessel disease" so after reading your post, I googled "age related small vessel disease" and found this article about it that sounds so much like the symptoms of MS:

http://www.lifeextension.com/magazine/2 ... ng/page-01

I'd never heard of the word "Leukoaraiosis" but what's strange is that it means "white matter lesions", Doesn't that sound SO FAMILIAR!!!

A lot in the article I link to above is very reminiscent of aspects of CCSVI: reduced brain perfusion, endothelial disfunction, plus symptoms that are reminiscent of MS like cognitive impairment, gait and balance issues, all said to be the result of "Leukoaraiosis" (age-related white matter lesions) that are tied to reduced brain perfusion and small vessel disease.

Sometimes I get this feeling that whatever causes MS must be right before our eyes, but we (and doctors) just don't see it. If I were a betting person (which I'm not) I'd bet money (if I had any, LOL!) that the cause of MS is somehow vascular in nature.
DX 6-09 RRMS, probably now SPMS
Still working, still walking
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Re: small vessel disease and MS

Postby Cece » Sun Jan 08, 2017 6:18 pm

Yes! I first read about leukoriasis in the days after my diagnosis, because my MRI report said that the white matter lesion was abnormal for someone under 60 (I was 30), and so I learned that the lesion and the symptoms would've been no big deal if I was old enough for age-related leukoriasis.
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About the leukoaraiosis connection

Postby frodo » Fri Jun 09, 2017 8:43 am

We had discussed leukoaraiosis at http://www.thisisms.com/forum/chronic-cerebrospinal-venous-insufficiency-ccsvi-f40/topic22309.html and http://www.thisisms.com/forum/ms-etiology-and-pathogenesis-f59/topic22806-150.html. It shares some characteristics with MS, like NAWM damage.

Well, it seems that even though they share some similarities, leukoaraiosis and MS lesions are different.

https://www.cambridge.org/core/journals ... C30E82FE9D

P.071 Multi-parametric MRI at 7 T enables differentiation of MS and age-related white matter lesions

Background: MRI criteria are used to support multiple sclerosis diagnosis and evolution. However, normal age-related lesions (ARLs) can be cofounded with MS white matter lesion (MSL).

Methods: Two Multiparametric 7T MRI scans 4 motnhs apart from 5 relapsing MS (RMS) patients were analyzed and compared to 5 matched healthy controls (HC) aiming to differentiate MSLs from ARLs. Six-echo GRE, FLAIR and MPRAGE sequences were acquired.

Results: Average size of ARLs was 51 mm3 and of MSLs was 69 mm3 (p=0.27). Both have the same general appearance on FLAIR and MPRAGE contrasts, but different contrast on the R2* and QS maps. Inter-visit variation on MPRAGE was significantly higher in MSLs. Inter-visit signal change in the other contrasts (QSM, R2* and FLAIR) was not significant.

Conclusions: R2*, QS maps and inter-visit variation using MPRAGE allowed differentiating MSLs from ARLs in 5 RMS with mean long term disease duration. This could improve correct early diagnosis and accurate lesion load accumulation evolution.
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Re: small vessel disease and MS

Postby centenarian100 » Wed Jun 21, 2017 3:30 pm

small vessel disease is different from MS. These are small infarcts in the distribution of small arteries.

They are correlated with vascular risk factors (diabetes, hypertension, age, smoking, sedentary lifestyle), stroke, coronary artery disease, and peripheral vascular disease

pathologically, they are often associated with lipohyalinosis of the small arteries

they tend to be morphologically different from MS plaques. They are small, fluffy, and poorly demarcated. They tend to be subcortical in location. Unlike MS lesions, they are rarely juxtacortical. They do not generally abut the ventricles or involve the corpus callosum. Has Frodo posted, they do not have central venules (unlike most MS lesions).

Cece: sometimes, MRI scans in people with MS or small vessel disease are ambiguous, and the two problems cannot necessarily be distinguished from one another in 100% cases. Also, radiologists tend to read films in a defensive and broad manner as they do not know the clinical history.
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