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Dilated perivascular spaces in small-vessel disease: a study in CADASIL.
[cadasil]
Dilated
perivascular
spaces
(
dPVS
)
have
previously
been
associated
with
aging
and
hypertension
-related
cerebral
microangiopathy
.
However
,
their
risk
factors
,
radiological
features
and
clinical
relevance
have
been
poorly
evaluated
in
CADASIL
(
cerebral
autosomal-dominant
arteriopathy
with
subcortical
infarcts
and
leukoencephalopathy
)
,
a
unique
model
to
investigate
the
pathophysiology
of
ischemic
small
-vessel
disease
.
The
purpose
of
this
study
was
to
investigate
these
different
aspects
in
a
large
cohort
of
patients
with
this
disorder
.
Demographic
and
MRI
data
of
344
patients
from
a
prospective
cohort
study
were
analyzed
.
The
severity
of
dPVS
was
evaluated
separately
in
the
anterior
temporal
lobes
,
subinsular
areas
,
basal
ganglia
and
white
matter
,
using
validated
semiquantitative
scales
.
Logistic
and
multiple
linear
regression
models
were
used
to
determine
the
risk
factors
associated
with
the
severity
of
dPVS
in
these
different
regions
and
their
relationships
with
cognition
,
disability
and
the
MRI
markers
of
the
disease
(
white
matter
hyperintensities
(
WMH
)
lacunar
infarcts
,
microbleeds
and
brain
parenchymal
fraction
(
BPF
)
)
.
The
severity
of
dPVS
was
found
to
increase
with
age
regardless
of
cerebral
area
(
p
<
0
.
001
)
.
In
contrast
with
dPVS
in
other
locations
,
the
severity
of
dPVS
in
the
temporal
lobes
or
subinsular
areas
was
also
found
strongly
and
specifically
related
to
the
extent
of
WMH
(
p
<
0
.
001
)
.
Conversely
,
no
significant
association
was
detected
with
lacunar
volume
,
number
of
microbleeds
or
BPF
.
A
high
degree
of
dPVS
in
the
white
matter
was
associated
with
lower
cognitive
performances
independently
of
age
and
other
MRI
markers
of
the
disease
including
BPF
(
p
≤
0
.
04
)
.
In
CADASIL
,
the
progression
of
the
hereditary
microangiopathy
with
aging
may
promote
the
dilation
of
perivascular
spaces
throughout
the
whole
brain
but
with
variable
extent
according
to
cerebral
location
.
In
temporal
lobes
and
subinsular
areas
,
dPVS
are
common
MRI
features
and
may
share
a
similar
pathogenesis
with
the
extension
of
WMH
during
the
course
of
the
disease
.
dPVS
may
also
participate
in
the
development
of
cognitive
decline
in
this
model
of
small
-vessel
disease
,
and
their
large
number
in
white
matter
may
alert
clinicians
to
a
higher
risk
of
cognitive
decline
in
CADASIL
.
Diseases
Validation
Diseases presenting
"lower cognitive performances independently of age"
symptom
cadasil
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