Cognitive dysfunction related to cerebral small vessel disease in young people with cerebral microbleeds as the main manifestation: two cases report and literature review

Abstract

Objective To analyze the clinical characteristics of 2 young patients with cerebral microhemorrhage as the main manifestation of cerebral small vessel disease (CSVD), and explore the relationship between the cerebral microhemorrhage and cognitive dysfunction. Methods and Results Both 2 patients were male, 39 years old, and had onset in their youth, diagnosed with cognitive dysfunction as the main complaint, all of them had a history of hypertension. The clinical manifestations were cognitive decline, including Case 1 with 28 score on Mini⁃Mental State Examination (MMSE) and 21 score on the Montreal Cognitive Assessment (MoCA). The MMSE of Case 2 was 26 score, the MoCA was 22 score, and Clinical Dementia Rating Scale (CDR) was one score. Laboratory tests ruled out other causes of cognitive dysfunction. The imaging findings of the 2 patients were mainly cerebral microhemorrhage. Among them, the cerebral microhemorrhage of the patient in Case 1 was located in the cortex and subcortex, mainly distributed in the cortex. In Case 2, cerebral microhemorrhage was mainly located in the deep brain. No genetic variation was found to be associated or partially associated with the clinical phenotype. Finally, Case 1 was diagnosed with CSVD, and the possibility of amyloid cerebrovascular disease was high. Case 2 was diagnosed with vascular dementia (VaD) related to CSVD. Conclusions The number and location of cerebral microhemorrhage are closely related to cognitive dysfunction in young people, but the cause of cerebral microhemorrhage needs to be further clarified.

Keywords

• cerebral small vessel disease
• cerebral hemorrhage
• cognition disorders
• hypertension
• young adult