Diagnostics Literature
October - December 2024
Clinical Neuropsychology
Leiden University
,Lectures & Associated Literature
Lecture Chapters
Dementia 1 13, 19, 21
Dementia 2 20, 21, 22
Multiple Sclerosis & Epilepsy 15, 23
Stroke & TBI 13, 14
Neuropsychiatry 25
Oncology & Brain Tumors 16
No lecture, but mandatory literature 17, 18, 24
,Chapter 13 → Vascular Cognitive Impairment
Introduction
● VCI includes several clinical syndromes & disorders
● Stroke often manifests as an acute loss of function in one side of body → loss of
strength, sensory disorders, loss of coordination, speaking difficulty
● Stroke is second leading cause of death
● Cause mild to severe cognitive decline
● Cognitive impairments affects functional recovery, quality of life, social participation
Vascular cognitive impairment
● Cognitive impairment from vascular issues → used to be called subcortical or multi
infarct or vascular dementia, now VCI as a conceptual framework (umbrella term)
● Within VCI → distinction between mild and major neurocognitive disorders (continuum)
● In clinical practice (severe) cognitive impairment from stroke is often not referred to as
dementia → dementia is traditionally thought of as progressive, while this is not always
the case in VCI
Epidemiology
● 40 000 people affected every year in the Netherlands
● Prevalence is rising due to aging (most people have a stroke at 65+)
● Young stroke (18-50) is in 15% of cases
● Cerebral hemorrhage is more linked to younger people than cerebral infarcts
● In recent decades number of deaths declined by better treatment methods and focus on
prevention
● 360 000 people are living with the consequences of a stroke in the Netherlands
Etiology of cerebral infarct and hemorrhage
● Introduction
, ○ Stroke → blood flow to brain is disturbed, brain is deprived of oxygen
○ Acute symptoms → inability to speak or use unilateral side of body
○ 80% have infarct (clot that clogs artery, prevents flow)
○ 20% have hemorrhage (ruptured blood vessel, bleeding in brain)
● Cerebral infarct
○ Embolism (blood clot) or stenosis of blood vessel obstructs an artery
○ Most common acute symptoms → drooping face, loss of body function, speaking
difficulty (one side of body)
○ Less common acute symptoms → vision loss, balance, coordination, headache,
fainting
○ Important to respond quickly and appropriately to minimize damage & prevent
complications
■ Acute phase → neurological assessment in hospital
■ Brain imaging (CT scan) → rule out hemorrhage or other causes
■ CT angiography (contrast) can show the presence & location
■ Patients at the hospital within a few hours with clear symptom onset can
receive intravenous thrombolytic therapy → drugs to dissolve blood clot
■ Endovascular treatment → microcatheters to remove blood clot
mechanically
● Transient ischemic attack
○ Temporary reduction in blood flow to small part of the brain
○ Symptoms occur and disappear within 24 hours
○ After TIA risk of second stroke is higher
○ In brain imaging often no abnormalities are found (only in ⅓ infarction found)
○ Many patient still report persistent cognitive complaints
○ 25% of TIAs are lacunar infarct → infarct in deeper structure of brain, causes a
small cavity (lacuna) to form
■ No clear clinical manifestation
■ At specific locations (thalamus & pons) can lead to motor impairments,
dysarthria, loss of sensation in acute phase
■ Symptoms usually disappear in the weeks & months after infarct but a
proportion do report persistent complaints (cognitive, fatigue, difficulty
working)
■ Associated with small blood vessel damage → dementia risk factor
● Cerebral hemorrhage
○ Rupture of brain blood vessel
○ Early symptoms → reduced consciousness, confusion, disorientation
■ Caused by increased intracranial pressure, mass effect of hemorrhage,
oedema (fluid in brain tissue)
○ Most often the bleeding is into the brain tissue (intracerebral) → acute treatment
is to reduce blood pressure to reduce pressure in the brain to stop the bleeding
○ Subarachnoid hemorrhage (SAH) → bleeding between meninges
■ Severe → death in ½ of patients before reached hospital
