What is Microvascular Ischemic Disease

Microvascular ischemic disease is where there are changes occurring in the small blood vessels present in the brain.⁽¹⁾ These changes can cause damage to the white matter, which is the brain tissue having nerve fibers and they act as the contact point to other areas of the brain.

Older adults commonly have small vessel ischemic disease and if it is not treated, then it can lead to strokes, mental decline, dementia, problems with walking and balance.

Other terms for microvascular ischemic disease are: cerebral small vessel disease and small vessel ischemic disease.

Microvascular ischemic disease can be of varying degrees, such as it can be mild, moderate or severe in nature.

Most of the older adults; especially those having a mild form of this condition, do not experience any symptoms, even with damage in some regions of the brain. This is known as “silent” disease. A study showed that about 20% of elderly people who were healthy suffered from silent damage in the brain and the majority of it was caused by small vessel disease.⁽²⁾

Even with no symptoms, the patient can experience very mild changes in their physical abilities and thinking. Small vessel disease which is more in severity will have symptoms like cognitive impairment, depression, and problems with balance and walking.^{(3, 4, 5)}

If small vessel disease causes a stroke, then symptoms consists of: sudden confusion; weakness or numbness; especially on one side of the body; dizziness; difficulty in understanding or speaking; loss of vision in one or both eyes; sudden, severe headache and loss of balance or coordination.

Having a stroke needs immediate medical treatment, as it is a medical emergency.

The exact cause of microvascular ischemic disease is not clear and it can occur as a result of accumulation of plaque and atherosclerosis where there is hardening of the walls of the small blood vessels that supply to the brain. Atherosclerosis is the same process which narrows, hardens and damages the blood vessels to the heart resulting in heart attacks.

This damage can disrupt the blood flow through the brain blood vessels resulting in lack of oxygen supply to the brain cells or neurons. Alternatively, it can also cause bleeding and leakage of the blood vessels in the brain causing damage to the adjacent neurons.

Some of the risk factors for microvascular ischemic disease are: high cholesterol; hypertension, smoking, increased age, diabetes, atrial fibrillation and hardened arteries.

One of the primary tests done to diagnose this condition is magnetic resonance imaging (MRI).

MRI makes use of radio waves and strong magnets to generate detailed pictures of the brain. Microvascular ischemic disease can be seen on an MRI in different ways like:

• White matter lesions that look like bright spots on the scan.
• Lacunar infarcts or small strokes.
• Bleeding from the small blood vessels present in the brain.

Treatment generally consists of management of risk factors, which cause the damage to the small blood vessels of the brain. Treatment of microvascular ischemic disease depends on the causes and risk factors and mostly consists of:

• Bringing down the cholesterol levels with exercise, diet and use of statin drugs as needed.
• Reducing the blood pressure if it is high by following a healthy diet, weight loss, exercise and using medication as needed. The goal for patients above the age of 60 is to maintain the systolic blood pressure under 150.
• Taking B vitamins helps in decreasing the homocysteine levels, as increased levels of this amino acid has been linked to blood clots and atherosclerosis.
• Prevention of strokes is done by taking blood thinning drugs such as aspirin.
• Quitting smoking helps a lot in preventing and managing microvascular ischemic disease.

The following tips can be used for protecting the small blood vessels in the brain and preventing stroke:

• If the patient is obese, then consult a dietitian and your doctor to help bring the weight under control and to a healthy range.
• Following a healthy diet plan is important, such as the DASH diet or Mediterranean diet, both of which are low in sugar, saturated fat and sodium and high in nutrition.
• Quit smoking and go for nicotine replacement products or medications and counseling to help with the urge to smoke.
• Always keep an eye on the blood pressure, blood sugar and cholesterol levels; as if they are out of range, then it can cause problems including microvascular ischemic disease.
• It is important to exercise for at least half an hour a day or as regularly as you can.
• Limit alcohol intake or abstain completely.

Small-vessel ischemic disease can be fatal and can cause severe complications, such as dementia, stroke and even death if it is not treated. Microvascular ischemic disease is responsible for about 20% of strokes and around 45% of dementia cases. Preventing damage to the small blood vessels is the best way to avoid these complications. For this, one must exercise regularly, follow a healthy diet and take medication according to the doctor’s recommendation to keep in check the blood pressure and cholesterol levels.

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