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Updated: Feb 22, 2026
Longitudinal In Vivo Imaging of the Cerebrovasculature: Relevance to CNS Diseases
Published on: December 6, 2016
Update on cerebral small vessel disease: a dynamic whole-brain disease
Yulu Shi1,2, Joanna M Wardlaw1
1Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
Insights
Cerebral small vessel disease (CSVD) is a common neurological condition in older adults, causing stroke and dementia. Standardizing diagnostic terms and viewing CSVD as a whole-brain disease are crucial for future research and treatment.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Cerebral small vessel disease (CSVD) is a prevalent neurological disorder in the elderly.
- It is associated with significant morbidity, including stroke, dementia, mood disturbances, and gait problems.
- Current diagnosis relies on neuroimaging markers like white matter hyperintensities and microbleeds, but definitions vary.
Purpose of the Study:
- To highlight the diagnostic challenges in CSVD due to inconsistent terminology.
- To advocate for standardized definitions and terms in CSVD research.
- To propose a shift in perspective, viewing CSVD as a diffuse 'whole-brain disease' rather than isolated lesions.
Main Methods:
- Review of existing literature on CSVD diagnostic criteria and imaging findings.
- Analysis of emerging evidence suggesting common underlying pathologies for various CSVD markers.
- Discussion of current therapeutic and preventive strategies and future research directions.
Main Results:
- Inconsistent terminology and definitions of CSVD imaging features hinder research interpretation.
- Emerging evidence suggests shared microvascular pathologies across different CSVD manifestations.
- CSVD should be considered a diffuse process affecting the entire brain.
Conclusions:
- Standardization of terms and definitions is essential for advancing CSVD research.
- Current treatments focus on antiplatelets and risk factor management due to limited pathophysiological understanding.
- Future research should explore therapies targeting the endothelium and blood-brain barrier, and investigate population-specific epidemiology.
Abstract:
Cerebral small vessel disease (CSVD) is a very common neurological disease in older people. It causes stroke and dementia, mood disturbance and gait problems. Since it is difficult to visualise CSVD pathologies in vivo, the diagnosis of CSVD has relied on imaging findings including white matter hyperintensities, lacunar ischaemic stroke, lacunes, microbleeds, visible perivascular spaces and many haemorrhagic strokes. However, variations in the use of definition and terms of these features have probably caused confusion and difficulties in interpreting results of previous studies. A standardised use of terms should be encouraged in CSVD research. These CSVD features have long been regarded as different lesions, but emerging evidence has indicated that they might share some common intrinsic microvascular pathologies and therefore, owing to its diffuse nature, CSVD should be regarded as a 'whole-brain disease'. Single antiplatelet (for acute lacunar ischaemic stroke) and management of traditional risk factors still remain the most important therapeutic and preventive approach, due to limited understanding of pathophysiology in CSVD. Increasing evidence suggests that new studies should consider drugs that target endothelium and blood-brain barrier to prevent and treat CSVD. Epidemiology of CSVD might differ in Asian compared with Western populations (where most results and guidelines about CSVD and stroke originate), but more community-based data and clear stratification of stroke types are required to address this.
