Mechanisms underlying sporadic cerebral small vessel disease: insights from neuroimaging

• Published in: Lancet neurology Vol. 12; no. 5
• Main Authors: Wardlaw, JM, Smith, C, Dichgans, M
• Format: Journal Article
• Language: English
• Published: 01-05-2013
• ISSN: 1474-4422; 1474-4465
• DOI: 10.1016/S1474-4422(13)70060-7

The term “cerebral small vessel disease” (SVD) describes a range of neuroimaging, pathological and associated clinical features. The latter range from none, to discrete focal neurological symptoms (stroke), to insidious global neurological dysfunction and dementia. The public health burden is considerable. The pathogenesis is largely unknown. Although associated with vascular risk factors, and generally considered to result from an intrinsic cerebral arteriolar occlusive disease, the pathological processes leading to the arteriolar disease, how these result in brain disease, how SVD lesions contribute to neurological or cognitive symptoms and the relationship to risk factors, have been the subject of much speculation. Pathology often reflects end-stage disease making determination of the earliest stages difficult. Neuroimaging provides considerable insights: the small vessels are not easily seen themselves, but the effects of their malfunction on the brain can be tracked on detailed brain imaging. We review the growing evidence for the most likely mechanisms.