Summary chapter 13 - Vascular Cognitive Impairment (VCI)
Definition:
Vascular cognitive impairment refers to the cognitive consequences of vascular disease,
ranging from mild cognitive impairment to dementia. A distinction is made
between mild and major cognitive impairment.
Major Cognitive Impairment Includes:
Post Stroke Dementia (PSD)
Multi-infarct (cortical) dementia
Subcortical ischaemic vascular dementia
Mixed dementia
Note: Severe cognitive impairment after a stroke is often not termed as dementia in clinical
practice because dementia is traditionally viewed as progressive, which is not always the case
with cognitive impairment after a stroke.
13.4 Aetiology of Cerebral Infarct and Haemorrhage
Cerebral Stroke:
Part of the brain is deprived of oxygen due to disturbed blood flow.
Cerebral infarct (80% of strokes): A blood clot (embolism) or local stenosis
obstructs a blood vessel, leading to reduced oxygen supply and potential permanent
damage.
Cerebral haemorrhage (20% of strokes): Bleeding in the brain causes damage.
Symptoms of Cerebral Infarct
Common Acute Symptoms:
Sudden facial drooping
Loss of body function
Difficulty speaking
Symptoms usually affect one side of the body
Loss of strength, sensory disorders, or movement control
Less Common Symptoms:
Decreased vision (e.g., double vision)
Balance issues
Impaired coordination
Severe headache
Fainting
, Diagnosis and Treatment
Acute Phase:
Quick response is essential to minimize brain damage.
Neurological assessment and CT scan (without contrast) to rule out haemorrhage.
CT angiography (with contrast) to determine stroke location.
Treatment:
Intravenous thrombolytic therapy: Dissolve the clot with drugs.
Endovascular treatment: Remove the clot mechanically using microcatheters.
Major Risk Factors for Ischaemic Stroke
Hypertension (high blood pressure, is when the pressure in your blood vessels is too
high (140/90 mmHg or higher).
Hypercholesterolaemia (Hypercholesterolemia is a disorder known for an excess of
low-density lipoprotein (LDL) in your blood)
Type 2-Diabetes
Obesity
Arteriosclerosis (occurs when the blood vessels that carry oxygen and nutrients from
the heart to the rest of the body (arteries) become thick and stiff)
Atrial fibrillation (an irregular heart rhythm that begins in your heart's upper
chambers)
Transient Ischaemic Attack (TIA)
Temporary reduction in blood flow to a small part of the brain.
Neurological symptoms disappear within 24 hours.
Increased risk of a second stroke.
Brain imaging: No abnormalities in most cases, but diffusion-weighted imaging
(DWI) may show acute infarction.
Lacunar Infarct
Occurs in small penetrating arteries
supplying the brain's deeper structures.
A small cavity (lacuna) forms.
Often no clear clinical symptoms.
Definition:
Vascular cognitive impairment refers to the cognitive consequences of vascular disease,
ranging from mild cognitive impairment to dementia. A distinction is made
between mild and major cognitive impairment.
Major Cognitive Impairment Includes:
Post Stroke Dementia (PSD)
Multi-infarct (cortical) dementia
Subcortical ischaemic vascular dementia
Mixed dementia
Note: Severe cognitive impairment after a stroke is often not termed as dementia in clinical
practice because dementia is traditionally viewed as progressive, which is not always the case
with cognitive impairment after a stroke.
13.4 Aetiology of Cerebral Infarct and Haemorrhage
Cerebral Stroke:
Part of the brain is deprived of oxygen due to disturbed blood flow.
Cerebral infarct (80% of strokes): A blood clot (embolism) or local stenosis
obstructs a blood vessel, leading to reduced oxygen supply and potential permanent
damage.
Cerebral haemorrhage (20% of strokes): Bleeding in the brain causes damage.
Symptoms of Cerebral Infarct
Common Acute Symptoms:
Sudden facial drooping
Loss of body function
Difficulty speaking
Symptoms usually affect one side of the body
Loss of strength, sensory disorders, or movement control
Less Common Symptoms:
Decreased vision (e.g., double vision)
Balance issues
Impaired coordination
Severe headache
Fainting
, Diagnosis and Treatment
Acute Phase:
Quick response is essential to minimize brain damage.
Neurological assessment and CT scan (without contrast) to rule out haemorrhage.
CT angiography (with contrast) to determine stroke location.
Treatment:
Intravenous thrombolytic therapy: Dissolve the clot with drugs.
Endovascular treatment: Remove the clot mechanically using microcatheters.
Major Risk Factors for Ischaemic Stroke
Hypertension (high blood pressure, is when the pressure in your blood vessels is too
high (140/90 mmHg or higher).
Hypercholesterolaemia (Hypercholesterolemia is a disorder known for an excess of
low-density lipoprotein (LDL) in your blood)
Type 2-Diabetes
Obesity
Arteriosclerosis (occurs when the blood vessels that carry oxygen and nutrients from
the heart to the rest of the body (arteries) become thick and stiff)
Atrial fibrillation (an irregular heart rhythm that begins in your heart's upper
chambers)
Transient Ischaemic Attack (TIA)
Temporary reduction in blood flow to a small part of the brain.
Neurological symptoms disappear within 24 hours.
Increased risk of a second stroke.
Brain imaging: No abnormalities in most cases, but diffusion-weighted imaging
(DWI) may show acute infarction.
Lacunar Infarct
Occurs in small penetrating arteries
supplying the brain's deeper structures.
A small cavity (lacuna) forms.
Often no clear clinical symptoms.
