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Stroke

Ischemic small vessel disease

04/21/2008

Question:

I could not find where to ask a question about the above. My MRI on the T2 and FLAIR images showed right frontal subcortical white matter 6mm x 3mm images suggestive of moderate to severe chronic ischemic small vessel disease. I do not know what this means and cannot get a straight answer. Does this mean I am prone to have, or likely to have a stroke? I am 59 years old, my family from my grandparents down on both sides of the family have had strokes and heart attacks, died mostly from heart attacks. I have headaches and have for years. My blood pressure is fine, I do not take meds for this. My bad collesteral is high and I am taking Zetia for that, but my good collesteral is very good. I want to know what this means (a down to earth, give me no flowers) answer. I am very scared and worried. Thank you.

Answer:

I have written extensively about small vessel disease, and would refer you to previous answers as well as an associated document on this topic.

In summary, findings like this do suggest a slightly higher risk for stroke. You do have several known risk factors including a family history, a history of migraines, and high cholesterol that put you at higher risk.

You should continue to work with your doctor(s) to minimize your risk for stroke. I cannot provide a specific prediction of your risk for stroke, although there are tools available that can give you an idea about your risk. You might try the Framingham Stroke Risk Score (http://www.nhlbi.nih.gov/about/framingham/stroke.htm). Please note that the limitations of this tool, which are spelled out at this link.

For more information:

Go to the Stroke health topic, where you can:

Response by:

Brett   Kissela, MD Brett Kissela, MD
Assistant Professor of Neurology
Director, Neurology Residency Program
College of Medicine
University of Cincinnati