Microvascular Ischemic Disease

brain-544403It is well known that body ages with time and all of its structures get more rigid and weaker during its waste of stem cells or mutation of the DNA or programmed death also called apoptosis. During that period, blood vessels mature too and get more exposed to even the smaller changes, which can affect their function and structure. It may be nothing serious, but it can mean something more severe, so how to figure it out? You’ve heard about MRI and saw those pictures of the brain before. But, what does it mean and what can we see with it? MRI stands for “magnetic resonance imaging” which is a medical imaging technology that uses the magnetic field in order to move atoms from organ tissues due to high-frequency radio waves and measure it, leaving an image on the screen. The Microvascular ischemic disease is one of the things that can be seen on this kind of diagnostics. MRI is a good choice for visualisation of the soft tissue, like blood vessels in the brain.

What Is Microvascular Ischemic Disease?

Microvascular ischemic disease (MID) is a small epilepsy-156105_1280vessel disease which narrows down the diameter of the vessel  and leads to reduced supply of the blood for brain tissue. This can happen in a lot of cases, from simple as aging to some kidney and heart diseases. The level of the blockage can be from a smaller diameter, to such as a clot in the vessel which can lead to infarction of the brain tissue. Depending on the blockage, it can go from ischemic disease to structural changes like lesion and necrosis, which means that the tissue that is being affected is dead. These are the changes that can be seen on MRI. When this happens, since a certain field of the brain has its own function, it can be visible in a form of malfunction of the same.

Some Causes That Can Lead To MID

The causes can lead to MID in a short amount of time, making it acute ischemic syndrome or can have chronic effect which eventually lead to disease:

  • Aging
  • High Cholesterol (Hypercholesterolemia)
  • Smoking
  • Stress
  • High Lever Of Sugar (Diabetes)
  • High Blood Pressure (Hypertension)
  • Heart And Kidney Disease
  • Thrombosis Or Thromboembolism

How Can You Spot Microvascular Ischemic Disease?

This disease can be in a form where there are none of the symptoms to a few or severe ones. One can have a small vessel disease and small stroke and not even know about it. In those who have chronic disease, symptoms can occur:

  • Loss Of Concentration
  • Disorientation
  • Loss Of Short Memory And Lack Of Organisation
  • Changes Of The Personality And Emotions
  • Trouble Speaking (Aphasia)
  • Trouble Swallowing (Dysphagia)
  • Lack Of Motor Movements (Apraxia)
  • Sudden Falls
  • Loss Of Visual Fields (Scotoma)
  • Loss Of Sensory Field (Neuropathy)

MRI Diagnostic Of Microvascular Ischemic Disease

Sometimes, when people don’t sense any symptoms and don’t have any problems, this kind of disease can go by unspotted. It can be revealed during some other scans and examinations, maybe if there is some other condition that demands MRI scan, such as a migraine, trauma, etc. MRI has no radiation, so to say, up till today, there were no side effects discovered. The contrast of gadolinium can be used to further enhance the spots of damaged tissue where they appear lighter than the rest of the tissue.

Normal MRI has a homogeneous look on the scan, where the brain gears or gyre are normal color and the structure doesn’t have any calcification which is the sign of necrosis and deposition of the calcium. That kind of spots are looking like they were some other kind of tissue or if they were lid up with a light spot.

Normal MRI

Consequences Of The Spots On MRI

A pathological MRI scan has this kind of lid spots where they can be from singular to multiple lesions on the brain. If these spots are small and it is a small vessel disease, doctors can advise you to live a healthier life, meaning that you should cut out any factors that can lead to more serious diseases like a stroke. It can be changing your diet, quitting smoking, eating low-fat food with less salt in it, activity, etc.

mri stroke
Microvascular Ischemic Disease

In other cases of chronic, severe problems, the therapy can be depending on the origin of the problem. If it is a high blood pressure, the doctor may subscribe an aggressive therapy like antihypertensives and diuretics. Other conditions such as atherosclerosis and high cholesterol are conditions that are treated with some medications like statins and aspirin. There are also meds for diabetics and drugs for heart disease such as beta blockers. The microvascular ischemic disease is an irreversible state which can’t be fixed and cured. The only thing that we can affect is the main cause. If we prevent it, it is the best medication.

The Ultimate Consequences Of The Disease

If the vessels clot to a level that they cannot be revascularized and fluent again, the organ starts expressing the symptoms which tell that it’s not functioning anymore and it can be for life:

  • Dementia. This kind of complication happens if the ischemic field of tissue seizes the part of the brain which controls the memory and cognitive function. This type of loss can cause Alzheimer’s disease.
  • Heart Attack. If the clot or the mri-782457_1920thrombus made in a small vessel in the brain gets to the heart by small circulation and gets caught in the small capillaries of the heart, it can cause a cardiac infarction leading to dyskinesia or abnormal movement of the affected part of the heart.
  • Kidney Failure. In some cases where there is a high level of sugar, it can also damage the small vessels in the kidneys, leading to kidney failure.
  • Stroke. And at last, it can cause stroke, and if it’s large enough it can cause death.


  1. if that MRI Results state Mild chronic microvascular white matter ischemic changes within the periventricular white matter does that indicate Microvascular ischemic disease?

    The reason for the mri was a sudden 4 hour period of blurred vision, followed by CT which was negative , a thourough eye exam the next day that found left sided visual field loss in both eyes.

    The MRI also started : no evidence of acute/ischemia or pathological intracranial enhancement

    • You have explained a complicated series of medical events and symptoms. These will be best addressed by a medical professional that is aware of your medical history. You may find benefit in speaking with a second medical professional for another opinion. Best of luck, April!

  2. I have been troubled and misdiagnosed for some time. I couldn’t have a MRI due to a magnetic stimulator but I had that removed to be tested for MS. I recently had an accident and white matter was discovered on my brain and the explanation was “Probably the beginnings of “Microvascular Ischemic Disease”. I have lupus and a thrombotic disease called antiphospholipid syndrome. It all makes sense now. Who diagnoses this? I have a hematologist for my blood coagulation but also have a vascular doctor. (In the past I was told to rule out “white matter disease” which I was told I was too young for at 40). I am now 52 and my brother has atherosclerosis.

    • Your general practitioner can recommend the next step in getting an accurate diagnosis. It sometimes is difficult to test for diseases, as you may have found when you were tested for MS. All you can do is tell your doctor your symptoms, get a recommendation for the right specialist and go from there. Good luck, Jeannie!

  3. I started having neurological issues in my early 40’s (am 60 now), which was diagnosed as early stage MS. After minimal issues for many years, started having significant issues again, and went to neurologist for updated testing. She determined via MRI that it’s actually Microvascular Disease. All symptoms are virtually identical, and I have most of those that are listed above. There were numerous (20-30) small spots visible via the MRI. I smoked for a number of years (quit in my 30’s), and cholesterol is high (although “good” cholesterol is very, very high, a common trait in my family). I’ve generally been very healthy, am very active, pretty healthy nutrionally, and 8yr breast cancer survivor. My work is very stressful, and I’m concerned about the impact of stress on this condition. When initially diagnosed with MS, I’d just come out of a very difficult divorce, moved from a job I loved to a high stress position, and was a newly single parent to very troubled 16yr old son (my life was nothing but stress). Is it possible those conditions, the extreme stress, was the driver of this disease? I know that when I’m in an extreme stress situation now, all of my symptoms are very much worse. Would appreciate some insight into the effect of stress and it’s impact going forward.

    • Stress can impact the disease, but so can cholesterol levels and smoking. It sounds like you have eliminated or alleviated the other health problems, so now you just need to lower some of the stress in your life. Is it possible to work less or take a less stressful career path at your work? If not, there are some practices like meditation that can help to reduce the impact of stress. You can also talk to your doctor about other options as well.

  4. Thank you so much for this very informative summary. I recently had an episode that what was later diagnosed as an acute stroke. The CT scan and MRI results were mostly unremarkable. One exception is “small cortical infarct in the left parietal operculum”. Background of chronic microvascular ischemic disease.” I’m a 59 year-old female, pack a day smoker and have been for about 45yrs. No other known health issues other than I was diagnosed with Crohn’s Disease 25 years ago; have not taken any meds for it except in the first year. I know I should quit and am making plans to do so. Is this damage reversible?

    • It would not be wise for us to say that your current experiences and symptoms are reversible. However, it is certain that you will be able to make great headway if you do quit smoking. E-cigarettes have nicotine free options. You can also use nicotine patches that slowly reduce your desire for nicotine. These two tools used together will certainly help you reduce your cravings. It is likely that it may help your thyroid based problems. Best of luck, Rochelle!

    • Thank you for your positive comment. We always appreciate such pleasant words. Please feel free to share more in the future. Have a great day, Raymond!


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