Cerebral Small Vessel Disease

Abstract

Cerebral small vessel disease (CSVD) is composed of several diseases affecting the small arteries, arterioles, venules, and capillaries of the brain, and refers to several pathological processes and etiologies. Neuroimaging features of CSVD include recent small subcortical infarcts, lacunes, white matter hyperintensities, perivascular spaces, microbleeds, and brain atrophy. The main clinical manifestations of CSVD include stroke, cognitive decline, dementia, psychiatric disorders, abnormal gait, and urinary incontinence. Currently, there are no specific preventive or therapeutic measures to improve this condition. In this review, we will discuss the pathophysiology, clinical aspects, neuroimaging, progress of research to treat and prevent CSVD and current treatment of this disease.

Keywords: Cerebral small vessel disease; MRI; arteriolosclerosis; cerebral amyloid angiopathy; dementia; neuroimaging; stroke syndrome.

Fig. 1.

Cerebral small vessel and its comprised compartments. (1): Posterior cerebral artery (2): Posterior communicating artery (3): Middle cerebral artery (4): Anterior cerebral artery (5): Anterior communicating artery (6): Internal carotid artery (7): Basilar artery. Small vessel atherosclerosis. (A). Eccentric atherosclerotic plaque in a perforating vessel in the putamen, causing significant narrowing of the lumen (asterisk). (Lammie, 2002 and Shi and Wardlaw, 2016)

Fig. 2.

The relationship between conditions such as diabetes, and hypertension influencing arteriolosclerosis. In addition, the figure shows how cerebral small vessel atherosclerosis is characterized. A series of changes will lead to lacunar infarct. CBF: cerebral blood flow.

Fig. 3.

Occlusion of the vessel lumen is represented and acute ischemia due to decreased flow in the vessel occurred.

Fig. 4.

The increase of amyloid deposits in the perivascular space consequently leads to increase in BBB permeability and decrease in tight junctions. The schematic effects of chronic oxidative stress in aging is shown. BBB: Blood–brain barrier.

Fig. 5.

Subcortical infarcts resulting from acute severe ischemia. It also shows microbleeds occurring in the cerebral cortex and gray/white matter junction due to deposition of amyloid. Cavitation is also shown as a result of acute severe ischemia.

Fig 6.

Gradient echo magnetic resonance imaging (left image) in a patient with small vessel disease and lacunar stroke showing microbleeds (arrowed) in the subcortical region not seen on fluid-attenuated inversion recovery (right image). Patel B, Markus HS. Magnetic resonance imaging in cerebral small vessel disease and its use as a surrogate disease marker. Int J Stroke. 2011 Feb;6(1):47–59.