Microangiopathy is a vascular condition that causes tiny areas of scarring in the brain, often due to blockages in very small blood vessels. These small changes can lead to symptoms like difficulty walking, urinary problems, and reduced cognitive function.
This condition, also called gliosis, cerebral microangiopathy, or small vessel disease, is commonly seen on brain MRI scans, especially in adults over 40. As people age, it becomes more common for certain small vessels in the brain to narrow or become blocked, which leads to these small areas of scarring.
Although gliosis is usually harmless and considered a normal finding, large amounts of microangiopathy or the presence of risk factors may require evaluation by a neurologist. Identifying the underlying cause helps ensure that any necessary treatment or monitoring is put in place.
Main symptoms
The main symptoms of microangiopathy are:
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Difficulty or inability to walk
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Urinary incontinence
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Decreased cognitive ability and progressive memory loss, without affecting daily functioning
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Vertigo and loss of balance
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Seizures
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Tremors
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Headache
In addition, continuous symptoms associated with stroke or transient ischemic attack (TIA) may appear, which normally improve within 24 hours.
In most cases, microangiopathy does not cause symptoms. However, a neurologist or the nearest emergency department should be consulted if symptoms of glioma appear, so that it can be diagnosed and the most appropriate treatment started.
Confirming a diagnosis
The diagnosis of cerebral microangiopathy is made by a neurologist or general practitioner through an assessment of symptoms, medical history, and blood tests such as complete blood count, blood clotting factors, glucose, hemoglobin A1c, cholesterol, triglycerides, C reactive protein (CRP), and kidney function tests, for example.
In addition, the doctor should request imaging tests such as brain MRI or CT scan, which allow visualization of spots or white areas.
Possible causes
The exact cause of cerebral microangiopathy is not fully known; however, it is understood to occur due to obstruction of the brain’s microvasculature, resulting in the formation of small scars.
Some factors may contribute to the development of cerebral microangiopathy, such as:
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Natural aging
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Diabetes, obesity, and high blood pressure
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High LDL cholesterol or high triglycerides
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Heart conditions such as arrhythmia, heart failure, and a history of heart attack
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Sleep apnea
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Chronic kidney disease
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Smoking and frequent excessive alcohol consumption
In addition, gliosis may also occur due to genetic changes, which is why some younger people may present this finding on MRI, as in multiple sclerosis.
When gliosis can be considered a health problem
Gliosis can be considered a sign of neurological changes when a person has high blood pressure, cholesterol abnormalities, or frequently smokes. These conditions increase the likelihood of more vessel blockages, which can cause more scars to form and accumulate, leading to neurological changes such as language and cognitive impairments, dementia, or ischemic stroke.
In addition, when large amounts of microangiopathy are visible, doctors often consider the possibility that the person may be close to having an ischemic stroke or may be experiencing memory loss due to neurological diseases.
Treatment options
Because microangiopathy is considered, in most cases, an imaging finding, no treatment or follow-up is necessary.
However, if a large amount of gliosis is detected, the doctor may recommend additional tests to help identify the cause so that the most appropriate treatment can be started.
Furthermore, it is important for people to keep chronic conditions well controlled, such as hypertension, cholesterol, and heart and kidney diseases, and to maintain healthy habits such as regular physical activity and a healthy, balanced diet, as this helps to reduce the risk factors associated with increasing amounts of microangiopathy.
Based on guidance from the Centers for Disease Control and Prevention, controlling blood pressure, cholesterol, and diabetes while adopting healthy lifestyle habits significantly lowers the risk of stroke and progression of small vessel disease.