Cerebral Small Vessel Disease

Cerebral small vessel disease (CSVD) is a frequent cause of stroke and vascular dementia. CSVD is characterized by alterations of the small blood vessels of the brain, i.e. penetrating arteries and arterioles, as well as capillaries and venules. The most common form of CSVD is related to aging and hypertension. The exact mechanisms are, however, poorly understood. Other important forms are cerebral amyloid angiopathy and inherited CSVD, such as CADASIL, the most common monogenic disease leading to stroke. Distinguishing between different forms of CSVD can have clinical implications. CSVD manifests with acute (ischemic or hemorrhagic stroke) and chronic symptoms. The latter include gait and mood disorders and vascular cognitive impairment. The small penetrating vessels cannot be visualized on routine MRI. Neuroimaging relies on characteristic tissue alterations, such as white matter hyperintensities, lacunes, microbleeds, cortical microinfarcts and atrophy. Especially regarding imaging findings, multiple sclerosis and leukodystrophies are relevant differential diagnoses. Current CSVD treatment is focused on the management of vascular risk factors.