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Friday, March 7, 2014
Ischemic small vessel disease
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.
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.
Brett Kissela, MD
Assistant Professor of Neurology
Director, Neurology Residency Program
College of Medicine
University of Cincinnati