Microvascular ischemic disease is a sign that there is reduced blood flow to areas of the brain. Many people who have an MRI of the brain turn out to have this condition as a result of the aging process. Arteries with age can become more rigid and narrow and less able to send blood to some of the areas. This is most common with certain health conditions like high blood pressure, diabetes, and elevated cholesterol. It can even be found in healthy people without chronic health problems. If there are no symptoms, your doctor may just recommend living a healthy lifestyle, eating healthy, and not smoking. 

What Is Chronic Microvascular Ischemic Disease?

It is the result of blockage to the small blood vessels in the brain. This happens over time due to changes in the blood vessels or blood clots. Ischemic changes are areas in the brain tissue that have died from lack of blood flow. Microvascular changes are so small that the disease may never cause any symptoms and the disease is usually found on a routine MRI done for other reasons.

In the presence of other conditions, this may lead to stroke, dementia, or other neurological issues.

What Causes Chronic Microvascular Ischemic Disease?

This disease can be caused by conditions that over time cause damage to the small blood vessels. These conditions include:

• Age
• Diabetes
• Hypertension
• Hypercholesterolemia (High Cholesterol)
• Stress
• Smoking

Signs and Symptoms 

Symptoms may include:

• Brain fog
• Trouble thinking and remembering
• Lack of organizational skills
• Withdrawal from social interactions
• Changes in personality
• Lack of logic
• Falls
• Trouble talking or swallowing
• Blurry vision
• Uncoordinated motor movements

Diagnosing Chronic Microvascular Ischemic Disease

It's normally diagnosed when an MRI is done for other reasons. There usually aren’t any symptoms in healthy people, so it isn’t something doctors would look for without a reason to look.

If you do have symptoms the doctor may do a mental exam to look for behavioral changes and memory loss. If that shows signs of a problem, an MRI and or a CT scan will be ordered to see the changes inside the blood vessels in the brain.

Figure: Chronic Microvascular Ischemic Disease MRI Sample

This MRI was done for a 62-year old woman who suffered from migraine headaches. An MRI was done four years prior with some of the changes see above. This MRI follow-up showed more spots and changes than the prior MRI so the patient was diagnosed. At the time of diagnosis, the patient showed signs of memory loss with a 2-year history of multiple falls. There is a medical history of diabetes and hypertension. Based on the criteria and the MRI results, the doctor was able to make the diagnosis.

Should I Worry About My Results?

If the appearance of small ischemic areas comes on with no other healthy conditions, doctors may not worry and advise you to live a healthy lifestyle. It is important to quit smoking, eat healthy, and get plenty of exercise. Obesity can contribute to other diseases that can lead to any kind of vascular disease.

In other instances, where there is a health condition along with more areas in the brain that appear to be chronic, your doctor will most likely place you on aggressive blood pressure protocols to reduce the risk of stroke. You will also need to get other health conditions stable such as lowering cholesterol, keeping blood sugar in normal ranges, and losing excess weight.

How Is Chronic Microvascular Ischemic Disease Treated?

Mild cases will just be monitored by your doctor and you will have to make any lifestyle changes that will improve and keep you healthy. You may need to change your diet, start and exercise program, and get rid of any unhealthy habits like smoking, excessive alcohol use, or street drug use.

However, it cannot be cured. Once certain areas of brain tissue have died, there is no way to bring them back. If you have conditions that will make it worse, the treatment is aimed at preventing progression of the disease and more damage. This includes:

• Blood pressure medications
• Dietary management to lower sodium, fat and sugar
• Cholesterol medications
• Blood sugar control
• Physical therapy
• Low dose Aspirin

There are new recommendations that any adult over the age of 55, but younger than 79 should routinely take a low-dose aspirin to prevent age related ischemic changes. This needs to be between you and your doctor, so always ask if a daily aspirin is okay for you. Aspiring taken during an actual stroke increases the risk of hemorrhage and is not safe.

Complications and Prognosis 

If blood vessels continue to be damaged to the point that blood flow is reduced to any organ, the complications of chronic microvascular ischemic disease can include:

• Dementia – This happens due to ischemia in the brain cells that regulate memory or cognitive function. It is thought these changes can also lead to Alzheimer’s disease.
• Kidney failure – In cases where high blood sugar levels from uncontrolled diabetes have damaged the small blood vessels in the kidneys, the kidneys can fail.
• Stroke – If clots grow large enough, a major stroke can result and cause widespread ischemia in the brain.
• Heart attack – Clots can form in small blood vessels around the heart and cause damage to the heart muscle. They call this the “silent killer” and can develop slowly over time. Then a sudden heart attack can hit and these are often very serious.