Abstract
Cerebral small vessel disease (SVD) refers to a group of disease conditions affecting the cerebral small vessels, which include the small arteries, arterioles, capillaries, and postcapillary venules in the brain. SVD is the primary cause of vascular cognitive impairment and gait disturbances in aged people. There are several types of SVD, though arteriolosclerosis, which is mainly associated with hypertension, aging, and diabetes mellitus, and cerebral amyloid angiopathy (CAA) comprise most SVD cases. The pathology of arteriolosclerosis-induced SVD is characterized by fibrinoid necrosis and lipohyalinosis, while CAA-associated SVD is characterized by progressive deposition of amyloid beta (Aβ) protein in the cerebral vessels. Brain magnetic resonance imaging (MRI) has been used for examination of SVD lesions; typical lesions are characterized by white matter hyperintensity, lacunar infarcts, enlargement of perivascular spaces (EPVS), microbleeds, cortical superficial siderosis (cSS), and cortical microinfarcts. The microvascular changes that occur in the small vessels are difficult to identify clearly; however, these consequent image findings can represent the SVD. There are two main strategies for prevention and treatment of SVD, i.e., pharmacotherapy and lifestyle modification. In this review, we discuss clinical features of SVD, experimental models replicating SVD, and treatments to further understand the pathological and clinical features of SVD.
Highlights
Advances in neuroimaging technology have led to the recognition of the existence of various small vessel pathologies affecting the brain, including both ischemia and hemorrhages, called cerebral small vessel disease (SVD)
The term SVD is an umbrella term used to describe several conditions that share common pathological, clinical, and neuroimaging features (Pantoni, 2010), and the two major types of SVD are arteriolosclerosis, which is mainly associated with hypertension, and cerebral amyloid angiopathy (CAA; Pantoni, 2010; Tomimoto, 2011)
Because magnetic resonance imaging (MRI) technology has allowed for improved visualization of SVD, can acute ischemic and hemorrhagic strokes be detected, and chronic microvascular changes that lead to dementia, as SVD is associated with strokes and with Alzheimer’s disease (Tomimoto, 2011)
Summary
Advances in neuroimaging technology have led to the recognition of the existence of various small vessel pathologies affecting the brain, including both ischemia and hemorrhages, called cerebral small vessel disease (SVD). Brain magnetic resonance imaging (MRI) shows diverse vascular lesions in patients with SVD, such as white matter lesions, lacunar infarcts, hematomas, microbleeds (MBs), and cortical superficial siderosis (cSS; Pantoni, 2010; Wardlaw et al, 2019). To determine the total MRI burden of SVD, calculation of a total SVD score has been described (Klarenbeek et al, 2013), based on four MRI features of SVD, including the presence of lacunae, the presence of MBs, the severity of the basal ganglia perivascular space, and the degree of WMH This weighted score has been shown to be associated with age, sex, and vascular risk factors, including hypertension and smoking (Staals et al, 2014). The number of patients enrolled was relatively small, another study showed that an aerobic exercise training program might have beneficial effects for patients with subcortical ischemic vascular cognitive impairments (Liu-Ambrose et al, 2016)
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