The Expanding Clinical Impact of Cerebral Small Vessel Diseases

Abstract

Cerebral small vessel disease (cSVD)-a pathology involving small perforating arterioles, capillaries, and probably venules 1 -is the commonest disorder of the aging brain, accounting for approximately 25% of acute ischemic strokes, 2 most spontaneous intracerebral hemorrhages, and contributing substantially to late-onset cognitive impairment and dementia. 3,4 Brain imaging with MRI or CT can readily identify markers of cSVD including white matter hyperintensities (WMHs), small deep infarcts (lacunes), cerebral microbleeds, enlarged perivascular spaces, superficial siderosis, brain atrophy, and cortical microinfarcts. 5 Several decades of research have demonstrated that cSVD, as visualized using these brain imaging biomarkers, not only is common in the general older population and people with stroke but also has functional relevance for cognitive function. [2][3][4] More recently, the clinical spectrum of cSVD has expanded further to include mood disorders, fatigue, sleep difficulties, bladder, bowel and sexual dysfunction, and neurobehavioral changes. 2,[4][5][6]