Chris Dewald: Chronic Small Vessel Ischemia

brain-newello, friends, caregivers and warriors of dealing with a stroke.  This is also termed “Small Vessel Disease” and also “White Matter” brain disease.  Well, what’s this mean to me?  It sure concerns a health giver or caregiver for sure.

According to , Small vessel disease—SVD—of the brain occurs when the small arteries and arterioles in the brain become damaged and deteriorate due to the buildup of plaque, the formation of small tears, or the arteries becoming hard and inflexible. This inhibits the blood flow in the brain, leading to the death of brain cells and the formation of lesions, or infarctions. Infarctions interfere with normal brain functions and result in neurological symptoms.

In my terms, I knew I had severe cerebral arteriosclerosis that contributed to 3 strokes.  Two of which was in the brain stem and one on the right side of my cerebellum at a later date.  There is no cure for this and it is “progressive.  Being progressive in this case is not any political term, this equates to continually growing more white matter.  White matter is the “loss” of brain due to no blood flow or no oxygen getting to the brain to continue functioning.  So, my brain is dying off.

I knew I had the arteriosclerosis and in that was not good in itself.  I forgot we had veins and other assorted blood pathways up there.  My official MRI states I have Chronic small vessel disease.

So why am I here writing this?  I term myself a “Stroker” in order to try and inflict some form of humor, albeit bad humor, to lighten my outlook to the future.  I am also going to post some warning signs of “White” matter changes due from the brain slowly dying off.  My dealing with this may save someone or cause them to seek help.  Medication can slow this condition down.  I am in the final stages of this and you need to know caregiver from one who is still cognizant.


Memory Impairment

Patients suffering from SVD often suffer from memory impairment. Although SVD does not cause complete memory loss, patients may have trouble recalling memories and may need prompting, according to the University of Tasmania Department of Rural Health.  Tasmania?  Ehh, what’s up doc?  I still have a great memory so this has not transpired, yet.


Thinking Difficulties

Severe SVD can also interfere with cognitive tasks. Thinking processes become slow, and although patients can usually provide an accurate answer, it takes longer. More advanced cognitive tasks, such as dealing with finances, performing mathematics or organizing tasks become difficult to perform.

Patients often fail to grasp their current health situation and fail to recognize that they need extra help. This can become dangerous as impaired motor coordination and balance problems worsen.

Can interfere?  This is a constant fight.  I am sporadic, can’t concentrate on one subject for long and never ask for help.  Although I do need the assistance, I shall fight this.  Dangerous is an understatement.  Many of those who have blockages are on a blood thinner.  This can cause serious complications from non-coagulation of your blood.


Gait Disturbances

Patients suffering from SVD often exhibit gait disturbances. This occurs because the areas of the brain most affected by SVD, including the pons and the basal ganglia, coordinate balance and movements. The basal ganglia contain a cluster of nerve cells deep inside the cortex of the brain. The basal ganglia receive information, process it and send it back through the thalamus to the motor cortex. When lesions form, the basal ganglia fail to send correct signals to the motor cortex resulting in uncoordinated movements.

Normally walking is an automatic process and does not require conscious thought. The lesions on the brain caused by SVD interrupt this process, and patients must concentrate in order to walk. Patients begin to dread walking for fear of falling. Their gait usually becomes slower as they begin to shuffle to avoid falls.

It takes total concentration for me to walk.  By total, I mean I hope a car is not coming as I am so committed on getting place to place I disregard my surroundings.


Balance Problems

In addition to affecting gait, SVD disrupts the patient’s sense of balance. This problem can become so severe the patient finds it difficult to remain upright. Normally, when a person loses balance, the reflexes take over, moving the arms and legs to regain stability. The brain lesions caused by SVD interfere with these reflexes, which leaves the patient vulnerable to frequent falls.  I have done the high wire act for a number of years.

According to,

The connection between stroke and dementia is slowly becoming more and more apparent. But what does the word “dementia” really mean? Depending on the context in which it is used, the word dementia evokes different mental pictures in different people. For some people, the word might evoke the image of a middle aged person with a severe psychiatric disturbance. For others it might bring up the image of a quiet and disheveled elderly man. So which is it? Before proceeding with the subject of stroke-induced dementia, let’s first clarify a few things about this condition.


What is Dementia?

In general terms, dementia is a global brain disorder in which multiple aspects of brain function are persistently compromised in a way that interferes with a person’s normal everyday functioning. However, dementia is not a single disorder. There are a myriad of disease processes which can lead to dementia, each one of which induces a different pattern of behavioral changes.

For instance, Alzheimer disease, perhaps the most well-known dementia of all, starts off late in the life (commonly between the ages of 65-85) and progresses slowly. Its most prominent symptoms include memory loss, delusions, hallucinations, anxiety, sleep disturbances, and depression. By contrast, fronto-temporal dementias start off earlier in life (between the ages of 50-60) and although they still progress slowly, they do so a little more rapidly than Alzheimer disease. Their most prominent features include personality changes such as loss of insight, loss of empathy for others, poor self-care, emotional explosiveness, and impulsiveness.

This is the important part I must advise the caregivers.  You are the most important links in your care.  The last paragraph symptoms are what have been going on in my neighborhood.  Increased memory loss, no delusions as of yet, but hallucinations are wild.  Right now I am aware they are hallucinations, but where does that go with continual white matter loss.  What do I see?  An example is thinking my dog is next to me when they are a pair of black sneakers.  Seeing my grandson in a chair at 3 am, doing a double take knowing he is nowhere about.  Audible hallucinations and maybe I’ll hit home with this.  People actually talking to me, but I am interpreting something different than what is actually said.  So caregiver, ever see this.  This can get you upset and it may not be in his/her control but I am sure it is aggravating.  I did see this stuff on television in comedy shows where it was a big laugh.  This is not so funny now but provides a great example.  Emotional explosiveness and striking out seems to be a new part of me.  I am volatile and I have gone into a shell with hiding in my room as I know there is no cure and of course it is termed depression.  So, I have to inform survivor and caregiver to get medical assistance.   This condition is real as I initially blew it off because “I’m invincible” and wear a Huge “S” on my shirt.  Let it be me, not you guys. Learn from me please.

“Vascular dementia” or “multi-infarct dementia”, which became the preferred term to define the specific pattern of cognitive decline associated with having multiple strokes. In recent years, however, this term has fallen out of favor as new imaging techniques have shown that even single strokes, referred by some as “strategic strokes,” can also cause someone to become demented. What’s more, in some cases, no clear strokes at all, but a condition closely associated with strokes which is known as “white matter disease” (also known as micro vascular disease or chronic ischemic brain changes) has also been associated with the onset of dementia.

So white matter disease was known as Vascular Dementia.  I was familiar with that, but change is in the sun.  Again, go see your doctor.  Inform yourself by looking for things on line.  Don’t be a “I got this” and 8 side applications of jungle disease.  Base your reading on known facts as in MRI’s and EEG’s.  The allow it to help you and the person in your care.  I love you all fighting any disease as of this nature.

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