From the Guidelines
The management approach for Subcortical Arteriosclerotic Leucoencephalopathy (SAL) should focus on aggressive control of vascular risk factors, including hypertension, diabetes, lipids, and lifestyle modifications, as recommended by the Canadian Stroke Best Practice Recommendations 1. The cornerstone of management involves assessing and managing medical and lifestyle vascular risk factors, such as hypertension, diabetes, lipids, atrial fibrillation, sleep disorders, diet, sodium intake, exercise, weight, alcohol intake, and smoking 1.
- Medical risk factors should be managed to achieve maximum risk reduction for first-ever or recurrent stroke, as these are associated with cognitive impairment 1.
- Referrals to appropriate specialists should be made to support and manage specific medical and lifestyle vascular risk factors and comorbidities 1.
- Individuals with SAL may require additional support, such as communication tools, memory aids, caregiver and family participation, and support, as appropriate to optimize participation in goal-setting and/or engagement in interventions 1. Key aspects of management include:
- Controlling hypertension to target blood pressure levels
- Managing lipids to achieve optimal levels
- Implementing lifestyle modifications, including a healthy diet, regular exercise, weight management, and smoking cessation
- Addressing cognitive symptoms and functional impairments through multidisciplinary interventions, including physical therapy, occupational therapy, and speech therapy.
From the Research
Management Approach for Subcortical Arteriosclerotic Leucoencephalopathy
The management approach for Subcortical Arteriosclerotic Leucoencephalopathy (SAE) is primarily focused on addressing the underlying vascular risk factors and managing the associated symptoms.
- Control of hypertension is crucial in preventing further progression of the disease 2, 3, 4, 5.
- Management of other vascular risk factors such as diabetes and hyperlipidemia is also important 3.
- The use of antiplatelet agents and anticoagulants may be considered in some cases to prevent further vascular events 2, 4.
- Cognitive and motor symptoms can be managed with medications and rehabilitation therapies 3, 4.
- In some cases, patients with SAE may present with symptoms similar to normal pressure hydrocephalus, and ventricular shunting may be considered 3.
Clinical Features and Diagnosis
The clinical features of SAE include:
- Persistent hypertension and systemic vascular disease 2
- Acute strokes and subacute accumulation of focal neurologic symptoms and signs 2
- Dementia and prominent motor signs and pseudobulbar palsy 2, 3, 4
- Hydrocephalus 2
- White matter lesions on computed tomography and nuclear magnetic resonance imaging 3, 4
Pathogenesis and Risk Factors
The pathogenesis of SAE is unknown, but possible mechanisms include: