関: cerebral arteriosclerosis、intracranial arteriosclerosis、intracranial atherosclerosis

WordNet

of or relating to the cerebrum or brain; "cerebral hemisphere"; "cerebral activity"
involving intelligence rather than emotions or instinct; "a cerebral approach to the problem"; "cerebral drama" (同)intellectual
a stage of arteriosclerosis involving fatty deposits (atheromas) inside the arterial walls, thus narrowing the arteries (同)coronary_artery_disease

PrepTutorEJDIC

大脳の,脳の / 頭脳的な,知的な
動脈硬化症

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/12/08 09:49:22」(JST)

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Cerebral atherosclerosis is a type of atherosclerosis where build-up of plaque in the blood vessels of the brain occurs. Some of the main components of the plaques are connective tissue, extracellular matrix, including collagen, proteoglycans, fibronectin, and elastic fibers; crystalline cholesterol, cholesteryl esters, and phospholipids; cells such as monocyte derived macrophages, T-lymphocytes, and smooth muscle cells.^[1] The plaque that builds up can lead to further complications such as stroke, as the plaque disrupts blood flow within the intracranial arterioles. This causes the downstream sections of the brain that would normally be supplied by the blocked artery to suffer from ischemia.^[2] Diagnosis of the disease is normally done through imaging technology such as angiograms or magnetic resonance imaging. The risk of cerebral atherosclerosis and its associated diseases appears to increase with increasing age;^[3] however there are numerous factors that can be controlled in attempt to lessen risk.^[4]

Diagnosis

Cerebral Angiogram obtained using an iodine based contrast medium

Diagnostic methods include:

Angiogram

Due to positive remodeling the plaque build-up shown on angiogram may appear further downstream on the x-ray where the luminal diameter would look normal even though there is severe narrowing at the real site. Because angiograms require x-rays to be visualized the number of times an individual can have it done over a year is limited by the guidelines for the amount of radiation they can be exposed to in a one year period.^[2]

Angio MRI of supra-aortic vessels after the injection of 20cc of gadolinium for contrast

Magnetic resonance imaging (MRI)

Magnetic resonance imaging has the ability to quantify the plaque anatomy and composition. This allows physicians to determine certain characteristics of the plaque such as how likely it is to break away from the wall and become an embolus. MRI does not use ionizing radiation, so the number of times that it is used on a single person is not a concern; however since it uses strong electric fields those who have metal implants in cannot use this technique.^[1]^[2]

Computed tomography (CT)

Multidirectional computed tomography (MDCT) is better than regular CT scans, because it can provide a higher spatial resolution and it has a shorter acquisition time. MDCT uses x-rays to obtain the image; however it can identify the composition of the plaque. Thus it can be determined whether the plaque is calcified plaque and lipid-rich plaque, so the inherent risks can be determined. Subjects are exposed to a substantial amount of radiation with this procedure, so their use is limited.^[2]

Treatment

Asymptomatic individuals with intracranial stenosis are typically told to take over the counter platelet inhibitors like aspirin whereas those with symptomatic presentation are prescribed anti-coagulation medications.^[2] For asymptomatic persons the idea is to stop the buildup of plaque from continuing. They are not experiencing symptoms; however if more build up occurs it is likely they will. For symptomatic individuals it is necessary to try and reduce the amount of stenosis. The anti-coagulation medications reduce the likelihood of further buildup while also trying to break down the current build up on the surface without an embolism forming. For those with severe stenosis that are at risk for impending stroke endovascular treatment is used. Depending on the individual and the location of the stenosis there are multiple treatments that can be undertaken. These include angioplasty, stent insertion, or bypass the blocked area.^[2]

Related diseases

Diseases associated with cerebral atherosclerosis include:

Hypertensive arteriopathy

This pathological process involves the thickening and damage of arteriole walls. It mainly affects the ends of the arterioles which are located in the deep gray nuclei and deep white matter of the brain. It is thought that this is what causes cerebral microbleeds in deep brain regions. This small vessel damage can also reduce the clearance of amyloid-β, thereby increasing the likelihood of CAA.^[5]

Diseases cerebral atherosclerosis and associated diseases can cause are:

Alzheimer's disease

Alzheimer's disease is a form of dementia that entails brain atrophy. Cerebral amyloid angiopathy is found in 90% of the cases at autopsy, with 25% being severe CAA.^[5]

Cerebral microbleeds (CMB)

Cerebral microbleeds have been observed during recent studies on dementia sufferers using MRI.^[6]

Stroke

Strokes occur from the sudden loss of blood flow to an area of the brain. The loss of flow is generally either from a blockage or hemorrhage. Studies of postmortem stroke cases have shown that intracranial arteriosclerotic plaque build up occurred in over half of the individuals and over one third of the overall cases had stenotic build up.^[2]

References

^ ^a ^b Corti R, Fuster V (2011). "Imaging of atherosclerosis: magnetic resonance imaging". European Heart Journal (Review) 32 (14): 1709–U149. doi:10.1093/eurheartj/ehr068. PMID 21508002.
^ ^a ^b ^c ^d ^e ^f ^g Degnan AJ, Gallagher G, Teng Z, Lu J, Liu Q, Gillard JH (September 2012). "MR angiography and imaging for the evaluation of middle cerebral artery atherosclerotic disease". American Journal of Neuroradiology (Review) 33 (8): 1427–1435. doi:10.3174/ajnr.A2697. PMID 21940802.
^ Korczyn AD (2005). "The underdiagnosis of the vascular contribution to dementia". Journal of the Neurological Sciences 229 (SI): 3–6. doi:10.1016/j.jns.2004.11.011. PMID 15760612.
^ Blankenhorn Dh, Hodis HN (1993). "Atherosclerosis--reversal with therapy". Western Journal of Medicine (Comparative study; review) 159 (2): 172–179. PMC 1022223. PMID 8212682.
^ ^a ^b Charidimou A, Werring DJ (2012). "Cerebral microbleeds and cognition in cerebrovascular disease: an update". Journal of the Neurological Sciences (Review) 322 (1-2): 50–55. doi:10.1016/j.jns.2012.05.052. PMID 22717258.
^ Charidimou A, Jäger HR, Werring DJ (November 2012). "Cerebral microbleed detection and mapping: principles, methodological aspects and rationale in vascular dementia". Exp. Gerontol. (Review) 47 (11): 843–52. doi:10.1016/j.exger.2012.06.008. PMID 22750456.

UpToDate Contents

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1. 頭蓋内大血管の動脈硬化 intracranial large artery atherosclerosis
2. 頸動脈内膜剥離術および頸動脈ステント留置術の麻酔 anesthesia for carotid endarterectomy and carotid stenting
3. 成人における中枢神経系の原発性血管炎 primary angiitis of the central nervous system in adults
4. 虚血性脳卒中および一過性脳虚血発作の特定の原因に対する二次予防 secondary prevention for specific causes of ischemic stroke and transient ischemic attack
5. アテローム性プラークに起因する塞栓症：アテローム塞栓症（コレステロール結晶塞栓症） embolism from atherosclerotic plaque atheroembolism cholesterol crystal embolism

English Journal

Cognitive impairment and cardiovascular disease: So near, so far.

Picano E1, Bruno RM2, Ferrari GF3, Bonuccelli U4.
International journal of cardiology.Int J Cardiol.2014 Jul 15;175(1):21-29. doi: 10.1016/j.ijcard.2014.05.004. Epub 2014 May 9.
In the spectrum of cognitive impairment, ranging from "pure" vascular dementia to Alzheimer's disease (AD), clinical interest has recently expanded from the brain to also include the vessels, shifting the pathophysiological focus from the leaves of synaptic dysfunction to the sap of cerebral microci
PMID 24856805

Digital subtraction angiography imaging characteristics of patients with extra-intracranial atherosclerosis and its relationship to stroke.

Liu J1, Jia XJ, Wang YJ, Zhang M, Zhang T, Zhou HD.
Cell biochemistry and biophysics.Cell Biochem Biophys.2014 Jul;69(3):599-604. doi: 10.1007/s12013-014-9839-1.
To investigate the angiographic characteristics and clinical features in patients with suspected extra-intracranial atherosclerosis in a large cohort of Chinese population. On the basis of digital subtraction angiography characteristics, pathological morphology of extra-intracranial atherosclerosis
PMID 24532024

Relationship between Carotid Artery Remodeling and Plaque Vulnerability with T1-Weighted Magnetic Resonance Imaging.

Fukuda K1, Iihara K2, Maruyama D1, Yamada N3, Ishibashi-Ueda H4.
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.J Stroke Cerebrovasc Dis.2014 Jul;23(6):1462-70. doi: 10.1016/j.jstrokecerebrovasdis.2013.12.010. Epub 2014 Feb 28.
BACKGROUND: The aim of this study was to validate the relationship between carotid artery remodeling defined as the carotid remodeling index (CRI) and plaque vulnerability by comparing the degree of outward remodeling calculated using 3-dimensional inversion recovery-based T1-weighted imaging (magne
PMID 24582790

Japanese Journal

Impact of polyvascular disease on clinical outcomes in patients undergoing coronary revascularization: An observation from the CREDO-Kyoto Registry Cohort-2.

Morikami Yuko,Natsuaki Masahiro,Morimoto Takeshi,Ono Koh,Nakagawa Yoshihisa,Furukawa Yutaka,Sakata Ryuzo,Aota Masaki,Okada Yukikatsu,Onoe Masahiko,Kawasuji Michio,Koshiji Takaaki,Nakajima Hiroyuki,Nishizawa Junichiro,Yamanaka Kazuo,Yamamoto Hiroyuki,Kimura Takeshi
Atherosclerosis
… [Objective]Patients with coronary artery disease (CAD) often have prior stroke or concomitant extra-cardiac vascular disease (EVD) such as cerebral, aortic, or peripheral vascular disease. …
NAID 120005293576

PADの診断・病態と新たな治療戦略(<特集>動脈硬化とアフェレシス)

福本真也
日本アフェレシス学会雑誌 32(1), 49-57, 2013-02-28
… Patients with PAD, a manifestation of systemic atherosclerosis, are at high risk for premature mortality and ischemic events in the coronary and cerebral arteries. … Therefore, the patients need prophylactic intervention for systemic atherosclerosis. …
NAID 110009580167

FHにおけるLDLアフェレシス : 最近の知見(<特集>動脈硬化とアフェレシス)

槇野久士,斯波真理子
日本アフェレシス学会雑誌 32(1), 43-48, 2013-02-28
… Homozygous patients exhibit severe hypercholesterolemia and premature atherosclerosis beginning in their childhood. … LDL-apheresis has been developed to prevent atherosclerosis by removal of atherogenic lipoproteins. … These results suggest that early introduction of LDL-apheresis can prevent atherosclerotic diseases in patients, and that heterozygous patients with severe atherosclerosis should continue LDL-apheresis therapy. …
NAID 110009580166

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★リンクテーブル★

リンク元	「脳動脈硬化症」「intracranial arteriosclerosis」「cerebral arteriosclerosis」「脳粥状硬化症」
関連記事	「cerebral」「atherosclerosis」