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. 2010 Jun 3;26(3):257–264. doi: 10.1007/s12264-010-1210-y

The clinical manifestations and pathophysiology of cerebral small vessel disease

脑小血管病的临床特点及病理生理机制

Ai-Juan Zhang 1,, Xin-Jun Yu 1, Mei Wang 2
PMCID: PMC5560297  PMID: 20502505

Abstract

Small vessel disease (SVD) is responsible for brain chronic circular disorder, and accounts for 20%–30% cases of ischemic stroke as well as cerebral hemorrhage, and to a great extent, encephalopathy. Binswanger’s disease and multiple small strokes, which are common in older people, are also closely associated with SVD. These disorders often cause decline in cognition, vascular dementia, impairment in gait and balance, mood depression, and urinary incontinence, and often brings great social and economic burdens. SVD-related encephalopathy increases the incidences of fall, disability and death in elderly people. With the aging of the society, more attention should be paid to the importance of early diagnosis and prophylactic treatment of SVD. Here the clinical manifestations and pathophysiology of SVD are reviewed.

Keywords: vascular dementia, gait disorder, urinary incontinence, lacunar infarction, Binswanger’s disease, brain ischemia, blood brain barrier

References

  • [1].Zubkov A.Y., Uschmann H., Rabinstein A.A. Rate of arterial occlusion in patients with acute ischemic stroke. Neurol Res. 2008;30(8):835–838. doi: 10.1179/174313208X340969. [DOI] [PubMed] [Google Scholar]
  • [2].Tomonaga M., Yamanouchi H., Tohgi H., Kameyama M. Clinicopathologic study of progressive subcortical vascular encephalopathy (Binswanger type) in the elderly. J Am Geriatr Soc. 1982;30(8):524–529. doi: 10.1111/j.1532-5415.1982.tb01691.x. [DOI] [PubMed] [Google Scholar]
  • [3].Nitkunan A., Charlton R.A., Barrick T.R., McIntyre D.J., Howe F.A., Markus H.S. Reduced N-acetylaspartate is consistent with axonal dysfunction in cerebral small vessel disease. NMR Biomed. 2009;22(3):285–291. doi: 10.1002/nbm.1322. [DOI] [PubMed] [Google Scholar]
  • [4].Shrestha I., Takahashi T., Nomura E., Ohtsuki T., Ohshita T., Ueno H., et al. Association between central systolic blood pressure, white matter lesions in cerebral MRI and carotid atherosclerosis. Hypertens Res. 2009;32(10):869–874. doi: 10.1038/hr.2009.121. [DOI] [PubMed] [Google Scholar]
  • [5].Fiehler J. Cerebral microbleeds: old leaks and new haemorrhages. Int J Stroke. 2006;1(3):122–130. doi: 10.1111/j.1747-4949.2006.00042.x. [DOI] [PubMed] [Google Scholar]
  • [6].Greenberg S.M., Vernooij M.W., Cordonnier C., Viswanathan A., Al-Shahi Salman R., Warach S., et al. Cerebral microbleeds: a guide to detection and interpretation. Lancet Neurol. 2009;8(2):165–174. doi: 10.1016/S1474-4422(09)70013-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [7].Küker W. Imaging of cerebral vasculitis. Int J Stroke. 2007;2(3):184–190. doi: 10.1111/j.1747-4949.2007.00134.x. [DOI] [PubMed] [Google Scholar]
  • [8].Black S., Gao F., Bilbao J. Understanding white matter disease. Imaging-pathological correlations in Vascular Cognitive Impairment. Stroke. 2009;40(3Suppl):S48–52. doi: 10.1161/STROKEAHA.108.537704. [DOI] [PubMed] [Google Scholar]
  • [9].Hendrikse J., Zwanenburg J.J., Visser F., Takahara T., Luijten P. Noninvasive depiction of the lenticulostriate arteries with timeof-flight MR angiography at 7.0 T. Cerebrovasc Dis. 2008;26(6):624–629. doi: 10.1159/000166838. [DOI] [PubMed] [Google Scholar]
  • [10].Maurice Victor, Allan H, Roper. Adams and Victor’s Principles of Neurology. 7th ed. 2001, 847–851.
  • [11].Norrving B. Lacunar infarcts: no black holes in the brain are benign. Pract Neurol. 2008;8(4):222–228. doi: 10.1136/jnnp.2008.153601. [DOI] [PubMed] [Google Scholar]
  • [12].Rapp J.H., Pan X.M., Neumann M., Hong M., Hollenbeck K., Liu J. Microemboli composed of cholesterol crystals disrupt the bloodbrain barrier and reduce cognition. Stroke. 2008;39(8):2354–2361. doi: 10.1161/STROKEAHA.107.496737. [DOI] [PubMed] [Google Scholar]
  • [13].Rao R., Tah V., Casas J.P., Hingorani A., Whittaker J., Smeeth L., et al. Ischaemic stroke subtypes and their genetic basis: A comprehensive meta-analysis of small and large vessel stroke. Eur Neurol. 2008;61(2):76–86. doi: 10.1159/000177939. [DOI] [PubMed] [Google Scholar]
  • [14].Staekenborg S.S., van Straaten E.C., van der Flier W.M., Lane R., Barkhof F., Scheltens P. Small vessel versus large vessel vascular dementia: Risk factors and MRI findings. J Neurol. 2008;255(11):1644–1651. doi: 10.1007/s00415-008-0944-1. [DOI] [PubMed] [Google Scholar]
  • [15].Rosenberg G.A. Inflammation and white matter damage in Vascular Cognitive Impairment. Stroke. 2009;40(3Suppl):S20–23. doi: 10.1161/STROKEAHA.108.533133. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [16].Wen Y.D., Zhang H.L., Qin Z.H. Inflammatory mechanism in ischemic neuronal injury. Neurosci Bull. 2006;22(3):171–182. [PubMed] [Google Scholar]
  • [17].Silbert L.C., Nelson C., Howieson D.B., Moore M.M., Kaye J.A. Impact of white matter hyperintensity volume progression on rate of cognitive and motor decline. Neurology. 2008;71(2):108–113. doi: 10.1212/01.wnl.0000316799.86917.37. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [18].Ishii N., Nishihara Y., Imamura T. Why do frontal lobe symptoms predominate in vascular dementia with lacunes? Neurology. 1986;36(3):340–345. doi: 10.1212/wnl.36.3.340. [DOI] [PubMed] [Google Scholar]
  • [19].Rosano C., Newman A.B., Katz R., Hirsch C.H., Kuller L.H. Association between lower digit symbol substitution test score and slower gait and greater risk of mortality and of developing incident disability in well-functioning older adults. J Am Geriatr Soc. 2008;56(9):1618–1625. doi: 10.1111/j.1532-5415.2008.01856.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [20].Waite L.M., Grayson D.A., Piguet O., Creasey H., Bennett H.P., Broe G.A. Gait slowing as a predictor of incident dementia: 6-year longitudinal data from the Sydney Older Persons Study. J Neurol Sci. 2005;229:89–93. doi: 10.1016/j.jns.2004.11.009. [DOI] [PubMed] [Google Scholar]
  • [21].Rosano C., Brach J., Longstreth W.T., Jr, Newman A.B. Quantitative measures of gait characteristics indicate prevalence of underlying subclinical structural brain abnormalities in high-functioning older adults. Neuroepidemiology. 2006;26(1):52–60. doi: 10.1159/000089240. [DOI] [PubMed] [Google Scholar]
  • [22].Acharya H.J., Bouchard T.P., Emery D.J., Camicioli R.M. Axial signs and magnetic resonance imaging correlates in Parkinson’s disease. Can J Neurol Sci. 2007;34(1):56–61. doi: 10.1017/s0317167100005795. [DOI] [PubMed] [Google Scholar]
  • [23].Srikanth V., Beare R., Blizzard L., Phan T., Stapleton J., Chen J., et al. Cerebral white matter lesions, gait, and the risk of incident falls: a prospective population-based study. Stroke. 2009;40(1):175–180. doi: 10.1161/STROKEAHA.108.524355. [DOI] [PubMed] [Google Scholar]
  • [24].Sonohara K., Kozaki K., Akishita M., Nagai K., Hasegawa H., Kuzuya M., et al. White matter lesions as a feature of cognitive impairment, low vitality and other symptoms of geriatric syndrome in the elderly. Geriatr Gerontol Int. 2008;8(2):93–100. doi: 10.1111/j.1447-0594.2008.00454.x. [DOI] [PubMed] [Google Scholar]
  • [25].Baezner H., Blahak C., Poggesi A., Pantoni L., Inzitari D., Chabriat H., et al. Association of gait and balance disorders with agerelated white matter changes: the LADIS study. Neurology. 2008;70(12):935–942. doi: 10.1212/01.wnl.0000305959.46197.e6. [DOI] [PubMed] [Google Scholar]
  • [26].Nadeau S.E. Gait apraxia: further clues to localization. Eur Neurol. 2007;58(3):142–145. doi: 10.1159/000104714. [DOI] [PubMed] [Google Scholar]
  • [27].Denays R., Tondeur M., Noël P., Ham H.R. Bilateral cerebral mediofrontal hypoactivity in Tc-99m HMPAO SPECT imaging. Clin Nucl Med. 1994;19(10):873–876. doi: 10.1097/00003072-199410000-00006. [DOI] [PubMed] [Google Scholar]
  • [28].Wolfson L., Wei X., Hall C.B., Panzer V., Wakefield D., Benson R.R., et al. Accrual of MRI white matter abnormalities in elderly with normal and impaired mobility. J Neurol Sci. 2005;232(1–2):23–27. doi: 10.1016/j.jns.2004.12.017. [DOI] [PubMed] [Google Scholar]
  • [29].Sibon I., Fenelon G., Quinn N.P., Tison F. Vascular parkinsonism. J Neurol. 2004;251(5):513–524. doi: 10.1007/s00415-004-0421-4. [DOI] [PubMed] [Google Scholar]
  • [30].da Silva E.G., Viana M.A., Quagliato E.M. Vascular parkinsonism: analysis of seven cases. Arq Neuropsiquiatr. 2006;64(3A):568–571. doi: 10.1590/s0004-282x2006000400005. [DOI] [PubMed] [Google Scholar]
  • [31].Factor S.A. The clinical spectrum of freezing of gait in atypical parkinsonism. Mov Disord. 2008;23(Suppl2):S431–438. doi: 10.1002/mds.21849. [DOI] [PubMed] [Google Scholar]
  • [32].Rektor I., Rektorová I., Kubová D. Vascular parkinsonism-an update. J Neurol Sci. 2006;248(1–2):185–191. doi: 10.1016/j.jns.2006.05.026. [DOI] [PubMed] [Google Scholar]
  • [33].Zijlmans J.C., Daniel S.E., Hughes A.J., Révész T., Lees A.J. Clinicopathological investigation of vascular parkinsonism, including clinical criteria for diagnosis. Mov Disord. 2004;19(6):630–640. doi: 10.1002/mds.20083. [DOI] [PubMed] [Google Scholar]
  • [34].Ihara M., Tomimoto H., Ishizu K., Yoshida H., Sawamoto N., Hashikawa K., et al. Association of vascular parkinsonism with impaired neuronal integrity in the striatum. J Neural Transm. 2007;114(5):577–584. doi: 10.1007/s00702-006-0610-7. [DOI] [PubMed] [Google Scholar]
  • [35].Kuo H.K., Lipsitz L.A. Cerebral white matter changes and geriatric syndromes: is there a link? J Gerontol A Biol Sci Med Sci. 2004;59(8):818–826. doi: 10.1093/gerona/59.8.m818. [DOI] [PubMed] [Google Scholar]
  • [36].Hashimoto M., Mori E. Impact of white matter changes on clinical manifestation of Alzheimer’s disease: A quantitative study. Stroke. 2000;31(9):2182–2188. doi: 10.1161/01.str.31.9.2182. [DOI] [PubMed] [Google Scholar]
  • [37].Román G.C., Royall D.R. Executive control function: a rational basis for the diagnosis of vascular dementia. Alzheimer Dis Assoc Disord. 1999;13(Suppl3):S69–80. doi: 10.1097/00002093-199912001-00012. [DOI] [PubMed] [Google Scholar]
  • [38].Chen Y., Chen X., Mok V.C., Lam W.W., Wong K.S., Tang W.K. Poststroke depression in patients with small subcortical infarcts. Clin Neurol Neurosurg. 2009;111(3):256–260. doi: 10.1016/j.clineuro.2008.10.008. [DOI] [PubMed] [Google Scholar]
  • [39].Reyes S., Viswanathan A., Godin O., Dufouil C., Benisty S., Hernandez K., et al. Apathy: a major symptom in CADASIL. Neurology. 2009;72(10):905–910. doi: 10.1212/01.wnl.0000344166.03470.f8. [DOI] [PubMed] [Google Scholar]
  • [40].Kato H., Yoshikawa T., Oku N., Imaizumi M., Takasawa M., Kimura Y., et al. Statistical parametric analysis of cerebral blood flow in vascular dementia with small-vessel disease using Tc-HMPAO SPECT. Cerebrovasc Dis. 2008;26(5):556–562. doi: 10.1159/000160213. [DOI] [PubMed] [Google Scholar]
  • [41].Huynh T.J., Murphy B., Pettersen J.A., Tu H., Sahlas D.J., Zhang L., et al. CT perfusion quantification of small-vessel ischemic severity. AJNR Am J Neuroradiol. 2008;29(10):1831–1836. doi: 10.3174/ajnr.A1238. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [42].Shibata M., Ohtani R., Ihara M., Tomimoto H. White matter lesions and glial activation in a novel mouse model of chronic cerebral hypoperfusion. Stroke. 2004;35(11):2598–2603. doi: 10.1161/01.STR.0000143725.19053.60. [DOI] [PubMed] [Google Scholar]
  • [43].Bugalho P., Viana-Baptista M., Jordão C., Secca M.F., Ferro J.M. Age-related white matter lesions are associated with reduction of the apparent diffusion coefficient in the cerebellum. Eur J Neurol. 2007;14(9):1063–1066. doi: 10.1111/j.1468-1331.2007.01817.x. [DOI] [PubMed] [Google Scholar]
  • [44].Staals J., Pieters B.M., Knottnerus I.L., Rouhl R.P., van Oostenbrugge R.J., Delanghe J.R., et al. Haptoglobin polymorphism and lacunar stroke. Curr Neurovasc Res. 2008;5(3):153–158. doi: 10.2174/156720208785425675. [DOI] [PubMed] [Google Scholar]
  • [45].Pruissen D.M., Kappelle L.J., Rosendaal F.R., Rouhl R.P., van Oostenbrugge R.J., Delanghe J.R. Prothrombotic gene variation in patients with large and small vessel disease. Neuroepidemiology. 2008;31(2):89–92. doi: 10.1159/000144089. [DOI] [PubMed] [Google Scholar]
  • [46].Quattrocolo G., Leombruni S., Vaula G., Bergui M., Riva A., Bradac G.B., et al. Autosomal dominant late-onset leukoencephalopathy. Clinical report of a new Italian family. Eur Neurol. 1997;37(1):53–61. doi: 10.1159/000117406. [DOI] [PubMed] [Google Scholar]
  • [47].Rufa A., Blardi P., De Lalla A., Cevenini G., De Stefano N., Zicari E., et al. Plasma levels of asymmetric dimethylarginine in cerebral autosomal dominant arteriopathy with subcortical infarct and leukoencephalopathy. Cerebrovasc Dis. 2008;26(6):636–640. doi: 10.1159/000166840. [DOI] [PubMed] [Google Scholar]
  • [48].Huang Z., Jacewicz M., Pfeiffer R.F. Anticardiolipin antibody in vascular parkinsonism. Mov Disord. 2002;17(5):992–997. doi: 10.1002/mds.10219. [DOI] [PubMed] [Google Scholar]
  • [49].Lee S.J., Kim J.S., Lee K.S., An J.Y., Kim W., Kim Y.I., et al. The leukoaraiosis is more prevalent in the large artery atherosclerosis stroke subtype among Korean patients with ischemic stroke. BMC Neurol. 2008;8:31. doi: 10.1186/1471-2377-8-31. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [50].Zhou L., Chen Y., Sun N., Liu X. Family history of hypertension and arterial elasticity characteristics in healthy young people. Hypertens Res. 2008;31(5):833–839. doi: 10.1291/hypres.31.833. [DOI] [PubMed] [Google Scholar]
  • [51].Khan U., Crossley C., Kalra L., Rudd A., Wolfe C.D., Collinson P., et al. Homocysteine and its relationship to stroke subtypes in a UK black population: the south London ethnicity and stroke study. Stroke. 2008;39(11):2943–2949. doi: 10.1161/STROKEAHA.107.513416. [DOI] [PubMed] [Google Scholar]
  • [52].Huber J.D. Diabetes, cognitive function, and the blood-brain barrier. Curr Pharm Des. 2008;14(16):1594–1600. doi: 10.2174/138161208784705441. [DOI] [PubMed] [Google Scholar]
  • [53].Sachidanandam K., Hutchinson J.R., Elgebaly M.M., Mezzetti E.M., Wang M.H., Ergul A. Differential effects of diet-Induced dyslipidemia and hyperglycemia on mesenteric resistance artery structure and function in type 2 diabetes. J Pharmacol Exp Ther. 2009;328(1):123–130. doi: 10.1124/jpet.108.142612. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [54].Tomimoto H., Ihara M., Wakita H., Ohtani R., Lin J.X., Akiguchi I., et al. Chronic cerebral hypoperfusion induces white matter lesions and loss of oligodendroglia with DNA fragmentation in the rat. Acta Neuropathol. 2003;106(6):527–534. doi: 10.1007/s00401-003-0749-3. [DOI] [PubMed] [Google Scholar]
  • [55].Utter S., Tamboli I.Y., Walter J., Upadhaya A.R., Birkenmeier G., Pietrzik C.U., et al. Cerebral small vessel disease-induced apolipoprotein E leakage is associated with Alzheimer disease and the accumulation of amyloid beta-protein in perivascular astrocytes. J Neuropathol Exp Neurol. 2008;67(9):842–856. doi: 10.1097/NEN.0b013e3181836a71. [DOI] [PubMed] [Google Scholar]
  • [56].Bradley W.G., Jr, Whittemore A.R., Watanabe A.S., Davis S.J., Teresi L.M., Homyak M. Association of deep white matter infarction with chronic communicating hydrocephalus: implications regarding the possible origin of normal-pressure hydrocephalus. AJNR Am J Neuroradiol. 1991;12(1):31–39. [PMC free article] [PubMed] [Google Scholar]
  • [57].Choi J.C. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy: a genetic cause of cerebral small vessel disease. J Clin Neurol. 2010;6(1):1–9. doi: 10.3988/jcn.2010.6.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [58].Quattrocolo G., Leombruni S., Vaula G., Bergui M., Riva A., et al. Autosomal dominant late-onset leukoencephalopathy. Clinical report of a new Italian family. Eur Neurol. 1997;37(1):53–61. doi: 10.1159/000117406. [DOI] [PubMed] [Google Scholar]
  • [59].Koennecke HC. Cerebral microbleeds on MRI: prevalence, associations, and potential clinical implications. Neurology 2006 [DOI] [PubMed]

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