Article Text

Update on cerebral small vessel disease: a dynamic whole-brain disease
  1. Yulu Shi1,2,
  2. Joanna M Wardlaw1
  1. 1Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
  2. 2Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, China
  1. Correspondence to Professor Joanna M Wardlaw; Joanna.Wardlaw{at}


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.

  • Cerebral Small Vessel Disease
  • Lacunar Infarct
  • White Matter Hyperintensities
  • Blood Brain Barrier
  • Microvascular dysfunction

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  • Abstract in Chinese

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  • Contributors This paper is based on a lecture given by JMW at the Chinese Stroke Association Inaugural Conference in 2015, Beijing. YS drafted the review which was then amended and approved by JMW.

  • Funding YS is supported by the China Scholarships Council. The work described in this paper was supported by the Wellcome Trust (WT088134/Z/09/A), the MRC, the Scottish Chief Scientist Office (CZB/4/281), Chest Heart Stroke Scotland, the UK HTA, etc.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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