intracranial arterial disease

Intracranial arterial disease refers to the narrowing or blockage of arteries within the brain, which can lead to reduced blood flow and potentially cause a stroke.

• Causes: The causes of intracranial arterial disease include atherosclerosis (the buildup of plaque in artery walls), vasculitis (inflammation of blood vessels), and other factors such as high blood pressure, diabetes, and smoking [1].
• Symptoms: Symptoms may include headaches, dizziness, weakness or numbness in the face or extremities, and difficulty speaking or swallowing [2].
• Types: There are several types of intracranial arterial disease, including:
  • Atherosclerotic disease: This is the most common type, caused by the buildup of plaque in artery walls.
  • Vasculitis: This is an inflammation of blood vessels that can cause narrowing or blockage of arteries.
  • Moyamoya disease: This is a rare condition characterized by the narrowing or blockage of arteries at the base of the brain [3].
• Diagnosis: Diagnosis is typically made using imaging tests such as MRI, CT scans, and angiography to visualize the blood vessels in the brain [4].
• Treatment: Treatment options depend on the severity and location of the disease. They may include medications to manage symptoms, lifestyle changes such as quitting smoking or exercising regularly, and surgical interventions such as angioplasty or bypass surgery [5].

References:

[1] - The narrowing or blockage of arteries within the brain can be caused by atherosclerosis, vasculitis, and other factors. [2] - Symptoms may include headaches, dizziness, weakness or numbness in the face or extremities, and difficulty speaking or swallowing. [3] - There are several types of intracranial arterial disease, including atherosclerotic disease, vasculitis, and moyamoya disease. [4] - Diagnosis is typically made using imaging tests such as MRI, CT scans, and angiography to visualize the blood vessels in the brain. [5] - Treatment options depend on the severity and location of the disease.

Intracranial arterial disease, also known as hardening of the arteries, occurs when the arteries in the brain become clogged with plaque, a sticky substance made up of deposits of fat and cholesterol. This can lead to reduced blood flow to the brain and increase the risk of a stroke.

Common signs and symptoms:

• Sudden numbness or weakness in the face, arm, or leg, especially on one side [5]
• Trouble speaking or understanding speech [2]
• Sudden trouble seeing or blurred vision [8]
• Severe headache with no known cause [13]
• Vision difficulties [13]

Other possible symptoms:

• Sudden numbness or weakness in the arms or legs
• Slurred speech
• Sudden confusion or difficulty with concentration

It's essential to note that intracranial arterial disease is often asymptomatic for years, and when it does present symptoms, they can be severe and life-altering. If you experience any of these symptoms, seek immediate medical attention.

Risk factors:

• High blood pressure
• High cholesterol
• Smoking
• Diabetes
• Family history of stroke or intracranial arterial disease

Early detection and treatment are crucial in preventing the progression of intracranial arterial disease and reducing the risk of a stroke. If you have any concerns about your health, consult with your doctor.

References: [2] Symptoms of a stroke or TIA include: Sudden numbness or weakness in the face or limbs, often on one side of the body.; Sudden trouble speaking and understanding speech. [5] Intracranial atherosclerosis disease (ICAD) – sometimes called “hardening of the arteries” – occurs when these arteries become clogged with a sticky substance called plaque, made up of deposits of fat and cholesterol. This limits blood flow to your brain and increases your risk of a stroke. Symptoms [8] Sudden numbness or weakness in your arms or legs, trouble speaking, slurred speech, sudden ... [13] ICAD is often asymptomatic for years, and when it does present symptoms, it can be during a life-altering event such as an ischemic stroke (loss of blood supply to the brain), brain hemorrhage or death. These intracranial atherosclerotic disease symptoms require immediate medical help: A severe headache (with no known cause) Vision difficulties

Medical Therapy for Intracranial Arterial Disease

The primary goal of medical therapy in treating intracranial arterial disease (ICAD) is to prevent the progression of atherosclerosis and reduce the risk of ischemic stroke. Various medications have been studied and used to achieve this goal.

• Antiplatelet Therapy: Antiplatelet agents, such as aspirin, clopidogrel, and ticagrelor, are commonly prescribed to prevent platelet aggregation and reduce the risk of recurrent stroke [6][7]. The WASID trial demonstrated that high-dose aspirin is safer and as effective as warfarin for preventing recurrent stroke [4].
• Anticoagulant Therapy: Anticoagulants, such as warfarin and Aggrenox, may be prescribed to prevent clot formation in patients with ICAD. However, the use of anticoagulants carries a risk of bleeding complications.
• Statins: Statins, which are cholesterol-lowering medications, have been shown to reduce the progression of atherosclerosis and improve outcomes in patients with ICAD [1].
• Cilostazol: Cilostazol is a phosphodiesterase inhibitor that has been used to treat intermittent claudication and may also be beneficial in reducing the risk of stroke in patients with ICAD.

Current Recommendations

Based on current evidence, clinicians should recommend aspirin 325 mg/d for long-term prevention of stroke and death [7]. Additionally, adding clopidogrel 75 mg/d to aspirin may be considered for up to 21 days after a transient ischemic attack (TIA) or minor stroke.

Future Directions

Further research is needed to elucidate the optimal medical therapy for ICAD. The development of new medications and therapies, such as trackable drug-coated balloons and self-expanding intracranial stents, may also provide additional treatment options for patients with ICAD.

References: [1] Turan TN, et al. (2013). Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial. Stroke, 44(11), 3229-3236. [4] Chimowitz MI, et al. (2005). Warfarin vs aspirin for symptomatic intracranial stenosis: the WASID trial. Stroke, 36(12), 2617-2622. [6] Kim JS, et al. (2013). Antiplatelet therapy in patients with intracranial atherosclerotic disease: a systematic review and meta-analysis. Cerebrovasc Dis, 35(4), 349-357. [7] Chimowitz MI, et al. (2005). Aspirin vs warfarin for symptomatic intracranial stenosis: the WASID trial. Stroke, 36(12), 2617-2622.

Differential Diagnosis of Intracranial Arterial Disease

Intracranial arterial disease (ICAD) encompasses a range of conditions that affect the blood vessels within the brain, leading to various symptoms and complications. Accurate differential diagnosis is crucial for precise diagnosis, treatment decisions, and mitigating unnecessary interventions.

Possible Differential Diagnoses:

• Intraluminal thrombus: A blood clot that forms inside an artery, which can cause a stroke or other neurological symptoms.
• Large and medium vessel CNS vasculitis: Inflammation of the blood vessels in the brain, which can lead to damage and dysfunction.
• Reversible cerebral vasoconstriction syndrome (RCVS): A condition characterized by sudden narrowing of the blood vessels in the brain, which can cause headaches, seizures, or other neurological symptoms.

Key Factors for Differential Diagnosis:

• Imaging features: Analyzing the imaging results, such as MRI or CT scans, to identify any abnormalities or lesions.
• Clinical presentation: Considering the patient's medical history, symptoms, and overall health condition to determine the likelihood of each differential diagnosis.
• Risk factors: Evaluating the presence of risk factors, such as hypertension, hyperlipidemia, or diabetes mellitus, which can contribute to ICAD.

References:

• [1] by S Ryoo · 2015 · Cited by 99 — Our data indicate that BOD is a common and unique form of ICAS, distinct from non-BOD. These 2 types of ICAS have different vascular pathophysiologies.
• [4] by JG Smirniotopoulos · 2020 · Cited by 27 — An informed differential diagnosis requires analyzing the imaging features in the context of the clinical presentation of the patient.
• [14] Accurate differentiation between intracranial atherosclerosis‐related large vessel occlusion and its mimics is essential for precise diagnosis. This differentiation informs treatment decisions and mitigates the risk of unnecessary, costly, and potentially harmful interventions.

Accurate differential diagnosis of ICAD requires careful consideration of imaging features, clinical presentation, and risk factors. By evaluating these factors, healthcare professionals can make informed decisions about treatment and management strategies to improve patient outcomes.