small vessel disease

[tescodirect]

I have asked this question before, but I cannot seem to find the post on here, so I'm trying again. Basically, is cerebral small vessel disease always progressive? I have been given this diagnosis following several MRI scans which show diffuse white matter lesions. I also have a bilateral nystagmus, and an elevated CSF protein level.  I am 43, and the only risk factor I had was elevated cholesterol: I am now on simvastatin and assassantin, and my cholesterol has reduced significantly. The diagnosis was made on the basis of the MRI scans, with the radiologist being pretty confident that this is small vessel disease, although other doctors I have spoken to are less confident that simply having elevated cholesterol would have caused this at my age.

So the first neurologist I saw said the important question is whether this is going to be progressive, which is not a question that has been answered in subsequent appointments. My cholesterol was the only risk factor, and that has now been reduced, so what are my chances?

[Venki1963]

Regarding CSVD none of the neurologists I have  so far seen in India have been able to answer. But the symptoms seems to be progressive so far for the past one year. Severe headaches, dizziness, anxiety problem and so on. The only thing neurologists doing is prescribing some pills for time being only. No permanent remedy. Diffused brain also makes me difficult in performing my day-to-day life properly. Sleep disorder, vivid dreams which can be remembered even many days later r the other problems. I think nobody is able to tell the effects of brain disorders. Expecting detailed reply.

[tescodirect]

Many thanks for your answer.
In terms of other tests, neurological exam was normal apart from nystagmus. I have had this done several times, and the nystagmus is not always evident. My symptoms have been a feeling of light-headedness, brain fog, and extreme fatigue, which have all got progressively worse. I also sweat profusely.

I had four MRI scans last year, none of which showed any change, and all of which were reported as showing diffuse small areas of demyelination in the subcortical white matter of the frontal lobes. There was no atrophy evident. All reports stated this is consistent with small vessel disease. I had two lumber punctures, which showed elevated CFS protein, roughly three times the normal level. My neurologist said it is significantly elevated, but she does not know the significance of this (if that makes sense). One of my other doctors told me that although it is elevated, it is at the same level as in my blood serum (I think), and therefore whatever is causing it is not something specific to the CNS. I have to admit I did not follow this entirely.

I have had various other tests, such as carotid dopplers and a test of blood clotting (thrombophylic?), but the only thing which was highlighted was elevated cholesterol. No other vascular risk factors: non-smoker, non-drinker, regular exercise, non-diabetic, non-hypertensive. Some family history of late-onset dementia, typically in the female family members who live into their 80s: no early-onset dementia to my knowledge. A second cousin once removed has relapsing-remitting MS, which is the only neurological problem I know of in the family.

My neurologist does not plan to see me again until July, probably after yet another MRI and lumbar puncture. Are there any other tests that I should request to explore some of the possible causes you mention? She did suggest an angiogram at some point, but has not followed up on this.

[Venki1963]

Iam 55 years male & have been suffering from CSVD for the past 1 year. as I took MRI. Cerebral Atrophy & Left hand & leg numbness for 1 year. Took Ecosprin 150 & Lipitab 10. Now the swelling receded but slepping disorder with vivid dreams continues. Severe headache after sleep. Routine work spoiled. Interested in day sleeping. Taking Elesert 100 & Clonazepam 5 for the past 3 months but now less effective. Severe headache kills me. I want to know whether my brain would have damaged further. Kindly clarify anybody.

[Dr. A. Srivastava]

Thank you for your question. Although without being able to placing your findings in context with clinical features and the results of other investigation such as hematological, MRI, I can not offer the specific advice & treatment you need. However, I will try to provide you some relevant information about your health concern.

It appears that it could be white matter disease due to micro-vesicular changes. In white matter disease there is pathology associated with the brain white matter, either exclusively or in combination with grey matter changes. It occurs due to metabolism errors, exogenous toxins released by virus, autoimmune disease, leukodystrophy, demyelination, and radiation effects. Spasticity, muscle weakness, paralysis, hyper-reflexia and movement disorder may be the clinical features associated with white matter disease that need to be evaluated thoroughly. However, it is sad to say that there is no permanent cure but conservative treatment & physiotherapy exercises that would help you to regain your normal function and stopping the further progression of the disease. Please consult a neurologist in this regards. Hope this helps.