Small Vessel Disease

Cerebral small vessel diseases are a group of disorders that result from the pathological alteration of the small blood vessels in the brain.

Globally, SVD is a huge problem. Of the 35-36 million people that are estimated to suffer from dementia, almost 50% of those have an SVD component. SVD also plays a causative role in a large proportion of strokes.

Clinical presentations of SVD include:

lacunar stroke
dementia
physical disabilities
depression

The pathophysiology of SVD is complex and not well understood. Most people in their 70’s have some neuroimaging signs of SVD. Many cases occur at random within the population, although a small proportion of cases are caused by genetic mutations. These include:

CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy)
CARASIL (cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy).

These genetic variants present with some similar phenotypes as sporadic cases.

Magnetic resonance imaging (MRI) can be used to image the patient’s brain and identify any abnormalities associated with SVD. MRI detects a variety of abnormal features in SVD patients, including:

subcortical infarcts
lacunes
white matter hyperintensities
enlarged perivascular spaces
cortical atrophy

Despite advances in imaging techniques and diagnosis, treatment for these disorders remains elusive. Development of therapies will be aided by advancing our understanding of the pathophysiology of this disease.

Further reading: