Cerebral Small Vessel Disease: A Review of Clinical, Radiological, and Histopathological Phenotypes

Abstract

Cerebral small vessel disease is difficult to directly visualize in vivo. Therefore, we rely on radiological phenotypes as surrogate markers of disease. The principal phenotypes of clinical interest are small, deep brain infarcts, cerebral white matter lesions, deep brain haemorrhages, and cerebral microbleeds. The causes or mechanisms underlying these phenotypes are understood in varying degrees of detail. This review aims to summarize recent knowledge regarding these phenotypes and place it in context with classical clinicopathological observations to provide mechanistic, clinical, and therapeutic insights into small vessel disease.

White Matter Hyperintensity Volume and Cerebral Perfusion in Older Individuals with Hypertension Using Arterial Spin-Labeling

“…To identify which confounders to include in model 2, we performed separate linear regression analyses for age, sex, brain parenchymal fraction, ATT, smoking status (current, former, never), history of stroke (including transient ischemic attack), history of other cardiovascular diseases (peripheral arterial disease, angina pectoris, myocardial infarction), diabetes mellitus, body mass index, antihypertensive drug use, systolic blood pressure, and diastolic blood pressure, because these could all potentially affect both CBF and WMH volumes. 1,4,5,31,32 Any of these variables individually associated with WMH volume adjusted for total brain volume with a P value Յ .1 were included as potential confounders in model 2.…”

“…They often appear together with other signs of cerebral small-vessel disease, an umbrella term for neuroradiologic anomalies often found in asymptomatic elderly individuals. 4,5 Histologically, confluent WMHs appear as a continuum of increasing tissue damage resembling chronic low-grade ischemia. 1,5 Therefore, WMHs may be the result of chronic low-grade white matter hypoperfusion.…”

“…2,3 Advanced age and hypertension are the strongest risk factors for WMHs, especially for the confluent subtype. [1][2][3][4] The pathophysiology of WMHs has not yet been fully elucidated. They often appear together with other signs of cerebral small-vessel disease, an umbrella term for neuroradiologic anomalies often found in asymptomatic elderly individuals.…”

Irregularly shaped lacunar infarction: risk factors and clinical significance

“…The primary pathogenesis of small lacunar infarctions is the occlusion of small penetrating arteries resulting from hypertensive lipo hyalinosis or fibroid necrosis 2,3 . Most lacunar infarcts appear as round, regular focal lesions, whereas other lacunar infarcts appear as irregularly shaped lesions 4 .…”

“…Lacunar infarcts are small infarcts with a diameter of 15-20 mm; they occur in the distributions of small penetra ting arteries such as arteries in the thalamus, gangliocap sular regions, corona radiate, and brainstem 1,2 . The primary pathogenesis of small lacunar infarctions is the occlusion of small penetrating arteries resulting from hypertensive lipo hyalinosis or fibroid necrosis 2,3 .…”