TY - JOUR
T1 - Circle of Willis abnormalities and their clinical importance in ageing brains: A cadaveric anatomical and pathological study
AU - Wijesinghe, P.
AU - Steinbusch, H.W.M.
AU - Shankar, S.K.
AU - Yasha, T.C.
AU - De Silva, K.R.D.
N1 - Funding Information:
This study was funded by Sri Lanka Council for Agricultural Research Policy (CARP Project Grant No? 12/684/515), Sri Lanka National Science Foundation (Grant No? RG 2000/M/16), University of Sri Jayewardenepura (Grant No? ASP/06/RE/2010/07; ASP/06/RE/2013/28), and the International Brain Research Organization?Asia Pacific Regional Committee (IBRO?APRC). We sincerely thank Judicial Medical Officers Drs. Sanjayah Hulathduwa and K. Sunil Kumara and the Pathologist Dr. Kamani Samarasinghe for helping us to carry out the research activities at their facilities. We would like to mention our special thanks to donor's family for their substantial contribution in this research.
Funding Information:
This study was funded by Sri Lanka Council for Agricultural Research Policy (CARP Project Grant No− 12/684/515 ), Sri Lanka National Science Foundation (Grant No− RG 2000/M/16 ), University of Sri Jayewardenepura (Grant No− ASP/06/RE/2010/07 ; ASP/06/RE/2013/28 ), and the International Brain Research Organization–Asia Pacific Regional Committee (IBRO–APRC) . We sincerely thank Judicial Medical Officers Drs. Sanjayah Hulathduwa and K. Sunil Kumara and the Pathologist Dr. Kamani Samarasinghe for helping us to carry out the research activities at their facilities. We would like to mention our special thanks to donor’s family for their substantial contribution in this research.
Publisher Copyright:
© 2020 Elsevier B.V.
PY - 2020/7/1
Y1 - 2020/7/1
N2 - The circle of Willis (CW) located at the base of the brain forms an important collateral network to maintain adequate cerebral perfusion, especially in clinical situations requiring compensatory changes in blood flow. Morphopathological changes in the CW may relate to the severity of the symptoms of certain neurodegenerative and cerebrovascular disorders. The purpose of this study was to investigate the CW abnormalities and their clinical importance in ageing brains. The CW was examined macroscopically in 73 formalin-fixed samples to determine the degree of stenosis of each CW component, atherosclerosis of the CW, hypoplasia (threshold diameter<1 mm), anatomical variations and aneurysms. Age-related neurodegenerative and cerebrovascular pathologies were screened using immunohistopathological techniques on specific neuroanatomical regions based on standard guidelines. The majority of the elderly brains -93 % (68/73) presented at least a single hypoplastic CW component at death. Anatomical variations were mostly identified in communicating arteries, followed by proximal posterior and anterior cerebral arteries. Arterial bifurcations were found to be the predominant sites for cerebral aneurysms. More than 90 % of the elderly brains presented CW atherosclerosis at death. CW abnormalities did not show any strong associations with neurodegenerative pathologies except for an "at risk" significant association observed between Braak's neurofibrillary tangle (NFT) stages 1-VI and CW atherosclerosis grades >= mild (p = 0.05). However, a significant association was observed between microscopic infarcts in deep white matter and hypoplasia in communicating arteries with Fisher's exact test (p<0.05). Overall, CW abnormalities were predominant in the ageing brains, however their relationships to the occurrence and severity of the symptoms of neurodegenerative pathologies were found to be low.
AB - The circle of Willis (CW) located at the base of the brain forms an important collateral network to maintain adequate cerebral perfusion, especially in clinical situations requiring compensatory changes in blood flow. Morphopathological changes in the CW may relate to the severity of the symptoms of certain neurodegenerative and cerebrovascular disorders. The purpose of this study was to investigate the CW abnormalities and their clinical importance in ageing brains. The CW was examined macroscopically in 73 formalin-fixed samples to determine the degree of stenosis of each CW component, atherosclerosis of the CW, hypoplasia (threshold diameter<1 mm), anatomical variations and aneurysms. Age-related neurodegenerative and cerebrovascular pathologies were screened using immunohistopathological techniques on specific neuroanatomical regions based on standard guidelines. The majority of the elderly brains -93 % (68/73) presented at least a single hypoplastic CW component at death. Anatomical variations were mostly identified in communicating arteries, followed by proximal posterior and anterior cerebral arteries. Arterial bifurcations were found to be the predominant sites for cerebral aneurysms. More than 90 % of the elderly brains presented CW atherosclerosis at death. CW abnormalities did not show any strong associations with neurodegenerative pathologies except for an "at risk" significant association observed between Braak's neurofibrillary tangle (NFT) stages 1-VI and CW atherosclerosis grades >= mild (p = 0.05). However, a significant association was observed between microscopic infarcts in deep white matter and hypoplasia in communicating arteries with Fisher's exact test (p<0.05). Overall, CW abnormalities were predominant in the ageing brains, however their relationships to the occurrence and severity of the symptoms of neurodegenerative pathologies were found to be low.
KW - ageing brains
KW - alzheimers-disease
KW - anatomical variations
KW - angiotensin-converting enzyme
KW - apolipoprotein-e
KW - circle of willis atherosclerosis
KW - collateral circulation
KW - deletion polymorphism
KW - diagnostic-criteria
KW - incomplete circle
KW - microscopic infarcts
KW - national institute
KW - neurodegenerative pathologies
KW - neuropathologic assessment
KW - vascular genetic risk factors
KW - vascular risk-factors
KW - Neurodegenerative pathologies
KW - Microscopic infarcts
KW - ALZHEIMERS-DISEASE
KW - Anatomical variations
KW - DELETION POLYMORPHISM
KW - ANGIOTENSIN-CONVERTING ENZYME
KW - APOLIPOPROTEIN-E
KW - NEUROPATHOLOGIC ASSESSMENT
KW - NATIONAL INSTITUTE
KW - Ageing brains
KW - INCOMPLETE CIRCLE
KW - COLLATERAL CIRCULATION
KW - Circle of Willis atherosclerosis
KW - VASCULAR RISK-FACTORS
KW - DIAGNOSTIC-CRITERIA
KW - Vascular genetic risk factors
U2 - 10.1016/j.jchemneu.2020.101772
DO - 10.1016/j.jchemneu.2020.101772
M3 - Article
C2 - 32165168
SN - 0891-0618
VL - 106
JO - Journal of Chemical Neuroanatomy
JF - Journal of Chemical Neuroanatomy
M1 - 101772
ER -