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The Spectrum of Cerebral Small Vessel Disease: Emerging Pathophysiologic Constructs and Management Strategies

Ryan T Muir1, Eric E Smith1

  • 1Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta T2N 1N4, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta T2N 1N4, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta T2N 1N4, Canada.

Neurologic Clinics
|June 27, 2024
PubMed

Insights

Cerebral small vessel disease (CSVD) impacts brain vessels and neurovascular integrity, leading to strokes and dementia. This overview covers CSVD's updated pathophysiology, clinical signs, and genetic risks.

Area of Science:

  • Neurology
  • Vascular Neurology
  • Neuroscience

Background:

  • Cerebral small vessel disease (CSVD) affects brain microvasculature, including arterioles, venules, and leptomeningeal vessels.
  • It compromises the neurovascular unit, blood-brain barrier, glia, and neurons.
  • CSVD is a significant cause of ischemic and hemorrhagic stroke, and dementia, posing future public health challenges.

Purpose of the Study:

  • To provide an overview of updated pathophysiologic frameworks for CSVD.
  • To discuss common and underappreciated clinical and neuroimaging manifestations of CSVD.
  • To review emerging genetic risk factors associated with sporadic CSVD.

Main Methods:

  • Literature review of updated pathophysiologic frameworks.
  • Synthesis of clinical and neuroimaging findings.
  • Analysis of emerging genetic risk factors.

Main Results:

  • CSVD encompasses diverse pathological changes in small cerebral vessels and associated brain structures.
  • Clinical and imaging features range from common to subtle, impacting diagnosis.
  • Specific genetic factors are increasingly linked to the development of sporadic CSVD.

Conclusions:

  • Understanding CSVD pathophysiology, manifestations, and genetics is crucial for addressing its impact on stroke and dementia.
  • Further research into genetic risk factors may reveal new therapeutic targets.
  • Comprehensive evaluation of CSVD is essential for managing neurological decline.

Keywords:
Cerebral amyloid angiopathyCerebral microbleedsCerebral small vessel diseaseDementiaHemorrhagic strokeLacunesVascular cognitive impairmentWhite matter hyperintensities

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