Large vessels check out with drama--devastating strokes where one side is paralyzed, a big heart attack, an aortic aneurysm, a gangrenous foot. Small vessel disease is insidious, and, once established, also devastating in a progressive sort of way.
Some years ago, my sixty-something year old patient with difficult-to-control hypertension was noted to have 'hypertensive retinopathy.' In other words, when her retina was visualized through dilated pupils by her opthamologist, the small vessels visible therein were noted to be thickened and narrowed (an appearance likened to copper wire), the arterioles smashed the little veins when their paths crossed (AV nicking), and 'cotton wool spots' denoted areas of inadequate blood flow.
The small blood vessels of the retina, which are the only small vessels that can be directly visualized during a physical exam, are quite similar to those of the brain. If you've got retinopathy, indicating that the blood supply to the back of the eye has been adversely affected by elevated blood pressure, your risk of similar troubles in the little blood vessels that supply the white matter of your brain is raised as well. In persons with similar risk factors for stroke such as hypertension, cigarette smoking, and elevated cholesterol, those with retinopathy are at 2-4 times greater risk for stroke than those without.
Dang if this patient did not go on to have an ischemic stroke* about five years after her retinopathy was found. An MRI done at the time of her stroke revealed extensive white matter disease. These little 'bright spots' noted on MRI deep within the brain are not bright spots for the brain at all, but rather represent areas with inadequate blood akin to the cotton wool spots seen in retinopathy. Cotton wool in the eyes and bright spots in the brain are dim prognostic signs for one's future health--in the Atherosclerosis Risk in Communities study, the five-year relative risk of stroke among subjects with both findings was 18 times greater than in participants with neither one.
The risk factors underlying such small vessel disease are aging, smoking, hypertension, diabetes and elevated cholesterol. This lady aged, she smoked, and her blood pressure was hard to control (multiple medications made her dizzy and prone to falling).
Yesterday, I got lab work back on another patient. Her estimated glomerular filtration rate or EGFR*** had fallen compared with the value from a year ago. She had an MRI done a year ago for an unrelated problem and was noted to have white matter disease. She's just my age (not so aged!), a non-smoker, her blood pressure is perfect on meds, and her cholesterol and blood sugar are fine. A newly published study in the journal Stroke** correlates decreasing kidney function with cerebral small vessel disease, supporting a link between vascular disease in the kidney with the same in the brain. She's off to a neurologist to see if she's a candidate for preventive blood thinners.
_____
*An ischemic stroke is caused by an interruption of blood flow whereas a hemorrhagic stroke is caused by a ruptured blood vessel in the brain.
**Ikram, MA, et al. Stroke. 2008; 39:55-61.
***For an explanation of EGFR, see EGFR.
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50 comments:
You've given me even more to think about! Small vessel disease! It was disconcerting to read about the younger patient in good health who didn't smoke who had it. That could be me in a few years--I'm 42.
Thank you for putting it all into words that are easy to understand.
Excellent post again - and it reminded me to call to book eye exams. His BP is medication controlled now.
Great, another thing to worry about! I'm on blood pressure medication which controls my blood pressure nicely. But it sounds as if that may not be enough!
I am 51 w/ small vessel disease, I have had multiple strokes...lost a lucretive job..about to looose my home...I'm scared!
I guess no one gives small vessel disease much thought, perhaps few even know about it.
Anonymous: I'm so sorry that you are struggling with this; I will keep you in my thoughts and prayers.
"Anonymous said...
I am 51 w/ small vessel disease"
I know this isn't any help, but you aren't alone. I'm a year younger than you. Along with small vessel disease I've got Trigeminal neuralgia and a seizure disorder. Hang in there! Those that you least expect to help may come through to help. My prayers are with you and all.
Please explain the difference in small vessel disease of the subcortical white matter of brain and multi infarct dementia. Where does binswangers(spelling?) fit in here. Thanks Hannah
Hi Hannah: These are all the same things.
I have a problem. My husband has been dealing with an illness for 4 years and finally the doctors admitted it was small vessel disease. His blood pressure is for the most part good as well as his blood sugar and cholesteral. The problem I am having is finding a doctor that will treat him. No one seems to want to bother with him and when he does see a doctor, they look at him and say "I have nothing new for you." What am I to do? I am desperate for help.
Dear Anon, I appreciate how frustrating this is for you. My understanding, however, is that other than blood pressure, blood sugar, and cholesterol control, there aren't any proven therapies for small vessel disease. I just checked PubMed on the latest research on using antiplatelet therapy (such as Plavix or Aggrenox) in this case and found nothing. I have been down this same road with my mom and some of my patients. I wish I had some good ideas for you.
I'm 63 years old and have suffered with severe headaches since 1988. Last month I had a MRI/MRA and discovered I have mild small vessel disease of the brain. For treatment the Dr put me on a variety of vitamins, minerals and antioxidents. In the past, weather changes had always triggered these headaches. This week we had several days of severe weather and I had only mild headaches. Don't know if these vitamins, etc are the reason but this is the best I have felt in years. My Mother has Alzheimers so some of the articles I read have had me worried, also. Anyone had any experience with vitamin treatments?
Concerned 63 year old
I know that this is three years "after the fact" of the publishing date, but I am a 59 year old female health care professional (RN), just diagnosed with small vessel disease resulting from metabolic syndrome, primary hypercoagulability syndrome,multiple vitamin deficiencies (B12, D, Folate, B6) and hypertension that remains uncontrolled on massive doses of meds. My mother had severe multiple infarct dementia when she died in 2006 at the age of 84, and I am having cognitive deficits already, and there is concern on my part and that of my neurologist as to whether or not I remain safe to continue working in my profession. This is enough to make me a little antsy. Anything new on this since the post was originally written?
Hi Karen,
How worrisome-my mother also had multi-stroke dementia and died at age 88. The very day you commented here, I was discussing MRI results with a woman in her late 70's distraught due to increasing lapses, the latest at church where she remained standing when the rest of the choir sat down. Her MRI showed white matter disease.
I'm sorry to say that I have no wise words to add. I hope you can find a good way to control your blood pressure. Dr. Larry McCleary has interesting suggestions of supplements in his book "The Brain Trust Program." Perhaps you've already looked into some of these compounds.
Best wishes,
Judy
I see everyone's post on here and their age. Well, I'm 36 years old and was diagnosed with Small Vessel Disease last August. It's really scarey being this young and not knowing what the future holds for me. I am on bp medication along with a blood thinner and medication for the headaches. I also have 2 children. I lost my mom at 17 and worry every single day if I will be here for them.
Hello, I'm 45 and was diagnosed with CSVD about 3 yrs ago due to me insisting something was wrong. I was falling a lot and was scared of having MS. The neurologist told me it was CSMD and that I had several plaque deposits in my brain, equivalent to someone in their 70's, but he didn't say anything else, so I assumed it was not a big deal. I go through periods where my mind is foggy or slow, and I fall often. It's as if I'm moving in slow motion when I fall but I can't seem to get my body to react to catch myself or regain my balance. Recently I'm having a hard time remembering words, forgetting what I'm talking about, and sometimes whatever I'm reading looks like a foreign language, nothing makes sense that I'm reading. Other days I feel more alert and can concentrate, it's so odd. I recently switched family doctors and she did some cognitive tests and said I need to see my neurologist again and have further cognitive testing. I am terrified of losing my mind at such a young age. My son doesn't seem to think what I have is a big deal. Am I over reacting? Is this disease common in younger people diagnosed at 42, like myself? Please please give me some answers, now I'm getting very scared! TIA.
Sorry, I meant CSVD, not CSMD.
Anonymous, I thought I was young, bless your heart you are way to young for this. I'm so sorry. I am also on meds for migraines, aspirin, lipitor, and 2 depression meds, with a mood stabilizer. I'm curious, is depression part of CSVD, does anyone know? Also, what about mood disorders? Is there any connection?
do you think that the cure may be within stem-cell research? My father has the disease 2005 following a series of small strokes and we like others are desperate for a cure and some hope...
Hi, I am 34 yrs. old and just been diagnosed with mild small vessel disease. the only information I am finding are for people 50-80 yrs. old. I haven't seen my neurologist yet and am really scared. I am a single mom with three boys. Should I be writing a will? I have a great job, but am finding it harder and harder to function. Feel like my days are numbered cuz not only am I going thru this, but I am having brain seizures as well. Am I a rare case? Can anyone around my age relate or help with any information on how I am suppose to live with this? Doctor info and meds are on thing, just trying to find out how many cases are like mine and how u cope.. Thanks!
I am 48 have never had high blood pressure my tri glycerates are little high doctor has put me on lipitor but my symptems seem to be getting worse having bad memory loss seems to be worse at night. I am very physically fit and the doctor does not seem to know why i have small vessel disease all the large vessels are perfect. The nuerologist has said my condition is serious how long does it take usually for things to get real bad and any suggestions?
I am 56 yrs old and beleive I had small vessel disease long before they discovered it. My entire familt seems to have it and it has been a long battle to get some answers but in my case they believe it is related to Rheumatic Heart Disease which can cause a whole host of illness if not properly diagnosed. My family wasn't diagnosed. I had a cervical fusion and got a staph infection that went untreated and they believe the staph infection is what caused the diseased vessels.It went undiagnosed for so long that it has destroyed all the arteries and affected every organ system. In my case treating it with antibiotics has helped some. Maybe a consult with infectious disease would be beneficial.
I'm 40 had a strange experience a couple of weeks ago. Now been told it was a mini Tia been put on a high dose of asprin they also found high blood pressure so on tablets for that now as well. Had a MRI the found white vessel matter disease. Doctor said normally see this on a 70 year olds brain. My gran had vascular dementia and Alzheimers should I be worried im also having problems with my muscles aching and feeling tight. X
hi just been given diagnosis of svd worried for future I work full time and care for my husband
70 yrs old , hemorratic stroke 10yrs ago, dizzy, balance walking problems diagnoses with small vessell disease and cerebral atrophy. Blood press (high) under control with meds, diabetic taking metformin. worry been having small time lapses and starting again with headache. Question is doctor does not seem concerned, check up every 3 months. worry how fast it is progressing . Memory is like typical 70 year old but some depression, no motivation (unlike me) and fatigue. Are these normal signs or are they all age related. I walk with a cane. Thank you
To all of you who have stopped here and left comments, I wish I had great answers for you. Some of you report the usual risk factors such as diabetes, hypertension, and high cholesterol, one 'anonymous' reported a history of rheumatic heart disease, spine surgery and a staph infection. Anything that causes inflammation such as rheumatic heart disease, chronic joint degeneration as in arthritis leading to a need for surgery, and chronic infections including gum disease can cause damage in both large and small blood vessels. Those of you who have developed small vessel disease in your 30s or 40s must be so stressed and distressed to be up against this problem without reasonable solutions.
Kate, you mention depression and 'no motivation' which is also a symptom of depression. Interestingly, stress and depression are also risk factors of vascular disease. This could become a vicious circle where having small vessel disease is depressing and the chemicals the body produces when depressed lead to further progression of the disease.
I too worry about small vessel disease as my mother, her two siblings, and her father all checked out with the piecemeal loss of function associated with the mini-strokes accompanying this condition. There is interesting research on beta-blockers as good preventive medicine for dementia as well as cancer (see my August 25, 2013 post for more info on the latter). Don't forget exercise for blood vessel health.
I appreciate everyone who's stopped by to comment!
Judy Paley aka Denver Doc
i have just been diagnosed with svd,also psoratic arthritis are they connected do you think
Unfortunately, anything that causes inflammation in the body such as psoriatic arthritis (or gum disease, smoking, trans fats, diabetes, central obesity, etc) increases risk of blood vessel troubles.
I was diagnosed with svd a few years back. My Dr said nothing could be done other than keeping my blood pressure and cholesterol under control, which I've done. In the past prior to diagnosis, I had a tiny infarct and issues with one of my eyes. I am now 71 with no additional problems and believe controlling the blood pressure and cholesterol is the answer for me. I've never smoked and that has probably helped the disease not to progress any further. I believe it's possible to have svd and remain healthy for a long time if you otherwise stay health with blood sugar, cholesterol, and blood pressure under control. Just my thoughts.
I am 63 years old never smoked,drink alcohol,tried to live a healthy life.I have SVD in my eyes,brain,and heart along with partial seizure,diabetes,TIA,hypertension that was uncontrollable.My doctors in Tn said I was going to die,that there was no cure for me.They said the only thing that could help me was gastric bypass,I was against because my weight was not a problem but they are my husband doctors also.They told him and of course he was for it. I had a version of gastric bypass that helped control it with two blood pressure meds for ayear and three months,then I moved to Tx now it is back and I have had a strok in both eye and the TIA is getting really bad. The doctors do not know what to do,so they keep sending me to other doctors.Ithank God for his faithfulness.To all of you "KEEP THE FAITH"
Hi Ive Had Long Term Raynuads Phenomeon..then was Diagnosed 2yr Ago with Psoriatic Arthrisis..After Having An op Recently..& Suffering severe Headaches i Demanded a MRI scan..Towhich they Found i had Small vessel ischamtic Disease feel so alone...now jst fpund this site! :/
Thank you. My best and dearest 42 year old friend has been diagnosed with this and in all my months of research I have not been able to find any better answers than what you share here. I am sad for my friend...but I will be there for her should the need arise. To those who have the disease....I am a cancer survivor (for now, 1 year)....do not accept gloom and doom. Life is lived one day at a time. enjoy it to its fullest! none of us know what the future holds...it is not set in stone. So heads up peeps and enjoy your day!
I have nothing to add or ask, only that i am 48 and was diagnosed with SVD yesterday. I was previously diagnosed with MS in 2009 as a result of an MRI (even though a lumbar puncture turned up negative). I'd gotten used to having MS and adjusted my life to this diagnosis. However, after my latest (and apparently "clearer") MRI, the Neuro now says SVD. The transition in thinking has shocked me and I'm not sure how I feel. While "my" MS was not going to shorten my life, SVD will. I'm giving myself a breather to get my head around it all and when I've come to terms with this, I will put my life in order, just in case I can no longer. I work with people with Dementia every day in aged care and honestly the thought terrifies me, so I have decided to write my own care plan to be discussed with my immediately family for if that day comes.
I've just been diagnosed with SVD also at 58. The research I've been reading seem to give conflicting advice on prognosis. One said that only some people with SVD show symptoms, and presumably have a normal lifespan, and another report said death occurs four years after diagnosis. But is 'diagnosis' from MRI scan evidence, or symptom onset? I also have ME/CFS and get brain fog and concentration issues because of that, not sure if it is due to the SVD. I feel I want to know as much as possible to prepare my family, especially as my husband is due to retire in 18 months time. We are currently planning when to downsize. I feel at peace though, knowing that my Lord and Saviour Jesus is in control of this situation, and my future is in His capable Hands. My thoughts and prayers are with all on this site who have posted. May God bring peace to your hearts and minds tonight.
I'm 29 years old and was just diagnosed with cerebral small vessel disease, what is it exactly? I had two mri's done both showed those white matter lesions. I've had multiple things happen from numbness on the right side of my body to severe memory issues. Having conversations then not even remembering I had it. Most of the memory issues are short term memory no long term. Should I be concerned?
I'm 29 years old and I've just been diagnosed with csvd. Honestly what is it really? I've had the mri's done of my brain both showed multiple white matter lesions. Symptoms is what lead the Dr to do mri's. I've had numbness on the right side of my body and memory and vision issues. But I'm not quite sure I understand what it exactly is?
Hi, I am an RN who have a STEMI heart attack in 2012. Due to length of time and plethora of cardiologists and PCP it took so long to diagnose small vessel disease which I was told is severe that it created apical cardiac ischemia. I had my heart attack at 51 yrs old. I have a 13 yr old daughter and a 32 yr marriage where spouse left as soon as I got sick and no longer made RN wages. Of course he had only worked part time for years and was not much of a husband, father or human. My doctor told me 80% or more of marriages and relationships end when the FEMALE becomes disabled, so that is just a fact of life. I now live in poverty with 50/50 custody of my daughter. Ex's Mommy shucked out thousands for the most aggressive lawyer in Moscow, Idaho and I had no money. I lost my home, my career, almost all my friends, my family disowned me because I got sick and could not work. I am not scared of dying. I have major angina all the time and no activity tolerance. My marriage was horrible and I spent the last 13 yrs of my life supporting my daughter and bum EX. He find a younger woman while we were still married and threw me away with the trash. I can't say I am a fan of human behavior and have lost all faith in humanity. I cannot find another man in my life because I am damaged goods. My life has had a few moments of joy and lots of emotional and physical pain. I no longer go to the hospital too many unpaid medical bills and EX and his bitch lawyer gave me all the debt because I am going to die soon anyways. There is so much Evil in this world, I really hate living.
Hi All,
Thank you so much for sharing your various experiences with SVD. As I read through the postings, I'm struck by how devastating this disease can be, and particularly difficult when so few people have even heard of it which means that family and friends may be more baffled than supportive of your plight. Heartbreaking how so many of you have had your lives turned upside down by SVD. I think it's time for me to do an updated post on this, so I will!
Warmly,
Denver Doc Judy
Hi Everyone,
So helpful reading some of these comments, Im 33 and have just been diagnosed with SVD, I have no history of high blood pressure, diabetes etc, ive been having problems for about 8yrs now with my health and only now has my consultant found that I have extensive SVD, I had no idea what this was and I still don't completely know if Im honest, everything I read seems to be aimed at people 50+ Im currently on aspirin and Gabapentin but nothing seems to help, I have two young children and work full time dealing with date critical & legal stuff so I too am pretty worried for what my future holds.
Im terrified that getting this so young and having it so bad already will have a major impact on my life, should I be making arrangements for my children?? Seems like Im over worrying but I just don't know where this is going.
Gemma
Hi I am 33 and have just been diagnosed with mild small vessel disease, I have been discharged from hospital and now waiting to see a neurologist, I am absolutely petrified as I don't know what this means other than it looks like my life expectancy has been cut tremendously short! Can anyone give me any information? I am a mum of 3 a carer for my youngest disabled son and just about to start a Dream career in the police force. I am due to get married in August and all I can think of is that I am going to die. Someone please help me......Thanks Emma
Wow so many of you i have just found out that i have small blood vessel disease and I am 42 have had uncontrollable swelling and inflammation foover a year in my left foot and the last couple of months silent but debilitating migraines causing vision loss and numbness on the left side of my body it is scary everytime it happens but no one told me till yesterday when i saw another gp other than my normal one!!
Wow so many of you i have just found out that i have small blood vessel disease and I am 42 have had uncontrollable swelling and inflammation foover a year in my left foot and the last couple of months silent but debilitating migraines causing vision loss and numbness on the left side of my body it is scary everytime it happens but no one told me till yesterday when i saw another gp other than my normal one!!
I totally understand how you feel I am 35 and just found out today that I have Small Vessel Disease.....I go to the nuerologist on Tuesday to discuss options because I also have lyme disease I don't have diabetes or high bp just awful headaches memory loss difficulty concentrating all things I though we're because of the lyme��
I stumbled up on this article of SVD. My 38 year old husband was just diagnosed yesterday with it. In Oct 2016 he had multiple strokes and just had an endarterectomy last month. We were originally told he had spots on his brain which prompted us to go to the neurologist but she said his brain looks good. However he does have SVD. Mild thankfully. But it's scary. He's 38, high cholesterol, smoker for 25 years (quit 5 weeks ago today), type 2 diabetes. His BP is just about the only thing he has going for him.
We were told yesterday his vessels have aged him about 15-20 years just from smoking.
I'm nervous. Is it guaranteed this will lead to dementia? What will life be like for us? We need to follow up with the cardiologist to check the vessels of his heart.
We're young, our kids are still babies (6+7). This is something you see in elderly people. We were told there's nothing that can be done for this. just don't smoke again.
How did u get your dr to test for this? Im 34 and believe i have this disease my dad died from it when i was 20. No one will take me seriously but i have all the symptoms someone please help me
Venkatesan. Im 54 years old I have been diagnised with CSVD. I took 2 MRIs in the gap of three and a half months both showed CSVD. Also Parkinson Disease. Tinitus disease. With all these I find it difficult to live as severe headache at the backportion of head. Dream problem as Sleeping Disorder every day occurs with severe headache. None of the Neurologist are helpful. Asprin and Lipitab tabs.are of little use. How can I live with all these. No proper medication for all these problems. Entire family are much worried. Is there any remedy?
I'm 26 and just got diagnosed with this. I don't have any of tjebqualifying symptoms. Just migraines with auras and a mini stroke (which may of been an actual stroke) last week that prompted the MRI. I can't find anything for someone my age having this.
I am 27 years old, and have had blackouts on the road where I don't know where I am going, I was diagnosed with csvd a week ago, what are some things I need to be concerned about, i have two young children, and would hate it if I forgot who they were ever.
Wow Beth, my eyes leaked reading your post and i felt the fear I sadly share. ive just turned 47, have worked so hard since the age of 14 with dairy farming and horses. Just before we move with bosses to new farm i had an embarassing episode of being completely lost in the wee hours of the morning out feeding my mobs of calves on a farm i knew like the back of my hand and yet i had to find a numbered gate to figure where i was. Id been out of sorts for near 3 wks and four days later ended up going through a&e for a check up. My life as i knew it has stopped, im not allowed to drive which means i have to be taken to my horse and not ride. My brilliant GP sent me for urgent ct scan which showed a 10mm lesion, then went nueroligist who told me couple weeks rest light duties and you will come right, whewww i thought!! Then i had my MRI and my GP called me in for urgent appt. im on blood thinners and atrovastatin. Waiting for urgent cardiologist appt, i have kept it together as my sons 23 & 25 work with us and live right next door, so ive fought my rising fear of “what now” with a sprinkling of panic. But ive never felt so isolated as i am now. As sad as I am with what we share I dont feel as alone anymore. I have chronic small vessel ischaemia, have many vague moments staring of into fairy land, struggle to get my mind ficused and my vision is pretty much double vision or at best blurry, easy fix according to neuro before MRI glasses with one very thick lense should do it. BUT the most heartbreaking of it all is that there is no finacial help with ACC or even WINZ due to hubbys wage nothing to do with my now lost income, i have 1400 cows babies to raise next month and doc says Oh no way!! We already punished in the worse way losing freedom, capabilty topped off with no financial security through recovery or the daiting future!!! I wish nothing but smile filled, memory making moments for you and I to cling to in the tough times ahead stay strong from the heart of this broken kiwi farmgirl
I am 42 years old and have been diagnosed with small vessel brain disease yesterday. My doctor has said that he will treat the risk factors - lower cholesterol, stop smoking, eat healthier, maintain a good BP. My question is can someone recover from this disease. What is the prognosis once you have been diagnosed.
I am 37 yrs old, I have had several seizures or episodes in the last 6 months. Which sent me to the neurologist. EEG was normal but MRI results unfortunately not. Showed scattered spots on my brain caused by SVD. My neurologist hasn't returned my calls and I'm very scared. I have speech issues, decline in my vision of my right eye, severe headache, I drop a lot of things I pick up. No high blood pressure, I quit smoking almost 2 months ago. I was crushed by a trailer ramp door weighing 400 to 500 lbs about 11 yrs ago. I just want to find out what CSVD is and if its serious or not a very big deal. I work in the medical field but for hearing. I also have 3 kids, the youngest is 5 yrs old. I wish someone could explain what it means to be so young with this disease.
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