Microvascular ischemic disease: What to know
Microvascular ischemic disease describes conditions that affect the small blood vessels in the brain. These conditions include stroke, cerebral hemorrhage, and dementia.
Age and high blood pressure are among the main risk factors for microvascular ischemic disease.
In this article, we provide more information on microvascular ischemic disease, including its symptoms, causes, and treatment.
Doctors use the term microvascular ischemic disease to refer to changes that occur in the walls of the blood vessels of the brain.
Conditions that affect these blood vessels can damage white matter in the brain. White matter contains nerve fibers that send signals between different parts of the brain.
Microvascular ischemic disease is a “silent” disease, which means that most people who have it do not experience noticeable symptoms.
However, doctors can look for signs of microvascular ischemic disease using MRI brain scans.
Microvascular ischemic disease commonly affects older adults. Without treatment, it can significantly contribute to cognitive decline, dementia, stroke, and walking problems.
The symptoms of microvascular ischemic disease can range from mild to severe, depending on the extent of the damage.
People who have mild forms of microvascular ischemic disease may have no symptoms. However, those with more advanced white matter damage may experience:
- difficulty thinking
- problems focusing
- memory loss
- changes in mood
- difficulty sleeping
- changes in bladder habits
Small vessel disease accounts for up to 25% of all ischemic strokes. The symptoms of a stroke include:
- a sudden and severe headache
- numbness in the face, arms, or legs
- vision problems
- difficulty breathing
Anyone experiencing symptoms of a stroke requires immediate medical attention.
Age is a significant risk factor for microvascular ischemic disease. According to a 2019 review, the disease affects just 5% of people who are at least 50 years of age but nearly 100% of people over the age of 90 years.
Other risk factors for microvascular ischemic disease include:
- high blood pressure
- high cholesterol
- a history of stroke and other cardiovascular diseases
- inflammation of the blood vessels due to infection or an overactive immune system
- exposure to radiation
The exact cause of microvascular ischemic disease remains poorly understood, however, as many factors can affect the blood vessels in the brain.
The accumulation of plaque, fatty tissue, or scar tissue inside arteries can partially or entirely restrict blood flow to the brain.
Without enough blood flow, certain areas of brain tissue may not receive enough oxygen, which can result in tissue damage or an ischemic stroke.
The blood vessels can also become hard and brittle. These hardened arteries can develop bulges called aneurysms, which can leak or burst, causing bleeding in the brain. This condition is called a hemorrhagic stroke.
Microvascular ischemic disease affects tiny blood vessels that are less than 0.5 millimeters (mm) in diameter, which makes the condition challenging to identify and treat with surgical procedures.
According to a 2015 article, treatment options include lifestyle changes and medications to help reduce the risk of stroke, cognitive decline, and physical disabilities.
A doctor may recommend one or more of the following treatment strategies, depending on a person’s risk factors:
- dietary changes and regular exercise for weight loss
- quitting smoking
- blood pressure medications, such as warfarin
- anti-inflammatory drugs, such as steroids, ibuprofen, and aspirin
- antiplatelet drugs, such as aspirin and cilostazol, to help prevent stroke
There are currently no specific recommendations on how to prevent microvascular ischemic disease.
However, people can lower their risk of developing microvascular ischemic disease by improving their cardiovascular health.
Steps to improve cardiovascular health include:
Microvascular ischemic disease does not always cause symptoms, but it can contribute to other medical conditions, such as stroke and dementia.
The risk of developing microvascular ischemic disease increases with age. People can speak with their doctor about reducing their risk by exercising regularly, making dietary changes, and taking medications that help control cholesterol levels and blood pressure.