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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 10341
Experience:  14 years as clinician in the field of Family Practice
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What is chronic small vessel disease of the brain?

Chronic small vessel disease is narrowing of the small vessels leading to the capillaries. The narrowing of vessels such as these may be systemic or involving your body as a whole. The main potential cause of this would be hypertension. You should check your blood pressure while seated and after resting for 5 minutes. This is the best way to get an accurate reading. You may use the automatic cuffs available at any pharmacy. The ones that measure at the wrist or the arm are usually OK but avoid the finger cuffs (these are usually inaccurate0. If after measuring 12 to 20 numbers and try to get an even mix of AM and PM readings, then the average of the systolic (upper number) and diastolic (lower number) should be reliable readings. It is healthy for you to be near 120/70 without being so low that you become symptomatic. Everyone has fluctuations in their blood pressure. Even within a few minutes or one day to the next you will likely find fairly wide ups and downs. This is normal. With your record you want to avoid throwing out numbers. You may recheck and record both. If your blood pressure average is >140/90 then you need to start medicine to help keep it under better control. If it is >135/85 then this is borderline and it should be watched and you should try to reduce the salt content of your diet and try to get regular exercise. The exercise teaches the blood vessels to relax and open wide and if you never exercise then you tend to reduce the capacity of your vascular system to open up to increase flow. Regular exercise will reduce your average blood pressure and will help to protect your blood flow. Other problems can cause small vessel disease other than hypertension. if you have diabetes then this can be a cause. Certain auto-immune diseases can cause this. Another possibility that might explain your neurologists seeming lack of concern would be if he/she felt that the neurologist's interpretation was an "over-read" (in other words he/she may have felt that the small vessel disease was not as apparent. It is not so uncommon for these two specialists to disagree on a MRI report.) I hope this information helps. Further questions are welcome if you have any. 

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Resolved Question:

What is chronic small vessel disease of the brain? I have been in the ER three times in six months, and my MRI reading concluded that I have this. I'm 44. Mother of two. My neurologist says not to worry? Could you please explain what it is, what causes it, and what I can do to prolong my life.

Submitted: 8 years ago.
Category: Health
Expert:  Anthony Bray, MD replied 8 years ago.

Chronic small vessel disease is narrowing of the small vessels leading to the capillaries. The narrowing of vessels such as these may be systemic or involving your body as a whole. The main potential cause of this would be hypertension. You should check your blood pressure while seated and after resting for 5 minutes. This is the best way to get an accurate reading. You may use the automatic cuffs available at any pharmacy. The ones that measure at the wrist or the arm are usually OK but avoid the finger cuffs (these are usually inaccurate0. If after measuring 12 to 20 numbers and try to get an even mix of AM and PM readings, then the average of the systolic (upper number) and diastolic (lower number) should be reliable readings. It is healthy for you to be near 120/70 without being so low that you become symptomatic. Everyone has fluctuations in their blood pressure. Even within a few minutes or one day to the next you will likely find fairly wide ups and downs. This is normal. With your record you want to avoid throwing out numbers. You may recheck and record both. If your blood pressure average is >140/90 then you need to start medicine to help keep it under better control. If it is >135/85 then this is borderline and it should be watched and you should try to reduce the salt content of your diet and try to get regular exercise. The exercise teaches the blood vessels to relax and open wide and if you never exercise then you tend to reduce the capacity of your vascular system to open up to increase flow. Regular exercise will reduce your average blood pressure and will help to protect your blood flow. Other problems can cause small vessel disease other than hypertension. if you have diabetes then this can be a cause. Certain auto-immune diseases can cause this. Another possibility that might explain your neurologists seeming lack of concern would be if he/she felt that the neurologist's interpretation was an "over-read" (in other words he/she may have felt that the small vessel disease was not as apparent. It is not so uncommon for these two specialists to disagree on a MRI report.) I hope this information helps. Further questions are welcome if you have any.

Customer: replied 8 years ago.

I do not have high blood pressure, never have. I do have high cholesterol. It runs in both sides of the family. They have run several tests and I am healthy other than this. Please explain the disease simply. I know if you have high blood pressure, high cholesterol, and you smoke it progresses the disease faster, what else?

Expert:  Anthony Bray, MD replied 8 years ago.

Yes--- high cholesterol should be treated; first with low fat diet is good advice for anyone. If your LDL (bad fraction of cholesterol) is greater than 160, then it should be treated with medication. If it is >130 and you have other risk factors such as a family history of premature heart attacks or strokes, then it should be treated. If your HDL is below 40 then this would become an independent risk factor. It turns out that HDL helps to pick up lipid particles that may be on vascular walls and remove them to take them to fat cells. The statin class of medicine is the best in terms of reducing the LDL cholesterol and in reducing the risk of heart attack or stroke by @30%. Niacin is the best at raising HDL cholesterol. Moderate alcohol also effects the raising of HDL alcohol. One or two glasses of wine in the evening is the best. This pattern of moderate drinking reflects a decrease in overall mortality but drinking 3 or more drinks a day does the opposite. (Too much alcohol becomes toxic to the brain, liver and heart. When it comes to the drinking of alcohol then the adage of moderation being the key is never more true. If you have a personal or family history of alcoholism, then I would not recommend it.) For people with small vessel ischemic disease such as diabetics then there is usually a sign of poor circulation that can be found by measuring your capillary reflex. You press one of your toes until it blanches pale then release the pressure. The red color from the capillaries filling should only take 2.0 seconds. If longer than this, then this would be consistent with small vessel capillary disease. I've not seen this so much at your age unless a diabetic or long term hypertensive. Hypothyroidism can affect the circulation so you might want to check and make sure that this is normal. This is a treatable cause. The complaint of feeling cold all the time is usual with this problem, fatigue, dry skin, constipation and thinning of the hair may be others. Scleroderma will cause hardening of the skin as well as vascular disease but this is rare. As I mentioned it is very possible that your vascular health may be more normal than implied by the radiologist's report. I don't blame you for being concerned; I would be as well with such an MRI report. If it is true that you have small vessel cebral vascular disease I've used Pletal in similar patients with proven vascular disease. The Pletal is indicated to improve circulation for those with peripheral vascular disease. It has effects to make red cells move more easily through capillaries but also dilates the small arterioles and improves perfusion. This drug may increase heart rate and its most common aggravating side effect is headaches. I'm not saying that you necessarily need this drug but I mention it as a possibility. If you were my patient, then I would need more than the MRI report but also some clinical indication such as the delayed capillary refill to prescribe this. This drug also reduces the risk of stroke. You may want to request a hemoglobin A1C test to make sure that you have normal blood sugar metabolism. A surprising number of people go undiagnosed for years with mild diabetes or glucose intolerance (the latter is pre-diabetes where the blood sugar after a meal stays too high for too long but your fasting blood sugars may still get to within normal range.) The AiC corresponds to what your blood sugar has been doing on average for the past 3 months. I hope this information helps. Further questions are welcome if you have any.

Customer: replied 8 years ago.

I suffer from migraines, and am on Topamax. I'm looking for a simple explanation to give to family and kids and friends. what it is, what they can expect for me, how to help me, and what things I should do and stay away from to stay healthier longer. I know a stroke and or dementia is inevitable.

Expert:  Anthony Bray, MD replied 8 years ago.

Well something is going to get all of us in the end if you look at it that way. It sounds like your main risk factor as far as what you have told me is the high cholesterol. The better this is controlled and the longer this is under control then all the better for you. If you need to be on medication, then don't be reluctant to take it. The statins show excellent statistics with regard to reducing risk of stroke, heart attack, and overall mortality. (Many people worry about the potential muscle side effects--these affect about one in ten patients and the meds are changed if this is the case--the question of abnormal liver function tests scares people much more than it actually presents a problem. With what to tell others this is tricky i guess as it may depend on how medically sophisticated the friends/family is and how open or private you wish to be. You might indicate that the MRI raised the question of adequate blood flow but more as a result of small blood vessels as opposed to any major vessel blockage. (The seeming conflict between the neurologist and the radiologist does put this into question) As to what you can do. Drink plenty of fluids--this is a poor habit adopted by most of us is relatively poor water/fluid intake. This improves the perfusion throughout the body. 8 to 12 ounces of fluid every two hours while awake is a good amount. Low fat diet to help with the cholesterol. Saturated fats are the main ones that contribute to high cholesterol. Exercise at least three days a week. Keep a periodic check on the blood pressure and record. Once a month is fine if you don't have a problem now. I recommend a multivitamin as a good health strategy that helps to ensure that you avoid potential dietary deficits that may relate to your likes and dislikes. I recommend CoQ10 as an excellent anti-oxidant and support of your metabolism. At your next annual physical have your homocysteine checked as this is emerging as another risk factor related to increased risk of vascular problems such as stroke and dementia. Taking additional folate is the simple solution if this is high. Have you C-reactive protein checked. This is a marker of inflammation and is non-specific as to what causes it. If elevated then you may be an increased risk of heart attack or stroke. this may affect at what age you are recommended to start aspirin as a preventive to heart attack or stroke. Independent of other risk factors it is recommended for women to start at age 55 and men at age 50.I hope this helps. Let me know if you have further questions or there is anything else that I can address to help you.

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