T.N. SEMENOVA, O.A. NOVOSADOVA, V.N. GRIGOREVA

 Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation, Nizhny Novgorod

 Contact details:

Semenova T.N. — postgraduate student of the Department of Neurology, Neurosurgery and Medical Genetics

Address: 10/1 Minina i Pozharskogo sq., Nizhny Novgorod, Russian Federation, 603005, tel.: +7 (831) 438-95-67, e-mail: neurotmdoc@gmail.com 

Lacunar ischemic stroke (LIS) is a stroke based on the acute development of a small, up to 15 mm in diameter, cerebral infarction, caused by damage to the small cerebral arteries/arterioles and clinically most often manifested by lacunar syndrome. Although LIS is most frequent in a clinic for hypertensive cerebral microangiopathy (HCM), cerebral amyloid angiopathy (CAA) may also be its cause. The differential diagnosis of HCM and CAA is important as a cause of LIS because treatment and secondary prevention of stroke in these diseases are different.

Material and methods. A comparative analysis of the clinical and neuroimaging features of acute hemispheric LIS in patients with probable CAA and HCM was performed. 66 patients (from 55 to 80 years) in the acute period of LIS were examined. Along with the clinical and neurological examination, all patients underwent a study of cognitive status using the Montreal scale for assessing cognitive functions and «Battery tests for evaluating frontal dysfunction». The diagnosis of probable CAA was carried out in accordance with the updated Boston criteria of 2010, the diagnosis of HCM was based on clinical data, anamnesis and results of brain neuroimaging.

Results. Probable CAA was diagnosed in 10 patients, and in all these cases it was combined with HCM (the 1^st group). Isolated HCM as the cause of LIS was observed in 56 patients (the 2^nd group). There was no statistical difference between the groups by sex, age, presence of concomitant diseases, localization of acute LIS and nature of motor and sensitive symptoms, however, cognitive impairment in general and regulatory dysfunction, in particular in the 1^st group, were statistically significantly more pronounced than in patients of the 2^nd groups.

Conclusion. The aggravation of regulatory dysfunction in patients with a combination of CAA and HCM is associated with an increase in the degree of diffuse damage to the deep sections of the white matter of the brain according to magnetic resonance imaging.

Key words: lacunar stroke, hypertensive cerebral microangiopathy, cerebral amyloid angiopathy, cognitive impairment, white matter hyperintensities. 

(For citation: Semenova T.N., Novosadova O.A., Grigoreva V.N. Clinical and neuroimaging comparisons of ischemic lacunar strokes in patients with probable cerebral amyloid angiopathy and hypertensive cerebral microangiopathy. Practical Medicine. 2019.  Vol. 17, № 7, P. 100-106)

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