Table 1.
Contrasting features of clinical, imaging, pathology and inflammation between CSVD and MS.
| CSVD | MS | |
|---|---|---|
| Clinical features | ||
| Course of disease | A chronic disease | A chronic disease |
| Attack events | Lacunar infarct and cerebral hemorrhage | Inflammatory demyelination activation |
| Disability | Accumulation | Accumulation |
| Neurodegeneration | Cognition, gait, neuropsychology and sleep disturbance | Cognition, gait, neuropsychology and sleep disturbance |
| Brain MRI | ||
| T2/FLAIR white matter hyperintensities | Focal and diffuse | Focal and diffuse |
| T1 hypointensities | Transient and persistent | Transient and persistent |
| Microbleeds | Common | Rare |
| Contrast enhancing lesions | Common at stroke recurrent stage, rare at remitting stage | Common at relapse phase, rare at remitting stage |
| Enlarged perivascular space | Centrum semiovale and basal ganglion region | Centrum semiovale region |
| Cerebral atrophy | Gray matter reduced and ventricles gradually expanded | Gray matter reduced and ventricles gradually expanded |
| Pathology features | ||
| Demyelinating region | Arterial watershed areas | High venule density and arterial watershed areas |
| Myelin | Selective loss of phospholipids and MAG with PLP preservation | Myelin loss with selective reduction of phospholipids |
| Axonal | Loss | Loss |
| Blood–brain barrier | Increased permeability and fibrin leakage | Increased permeability and fibrin leakage |
| Perivascular | Perivascular collagenases and inflammatory | Perivascular collagenases and inflammatory cuffs |
| Inflammatory cell | Microglia and astrocyte activation and lymphocytic infiltration | Microglia and astrocyte activation and lymphocytic infiltration |
| Inflammation features | ||
| Triggering events for immune activation | Cell death products, microglia activation | Mostly unidentified |
| Location of activation signals | Brain and periphery | Periphery |
| Antigen specificity | Mostly antigen-specific cells and antigen-specific antibody | Mostly antigen-specific cells |
| Immune effector cells | Combined effects of many cells, no dominant cell type | Coordinated events dominated by T cells |
| Role of inflammatory mediators | Presumably many, including IFN-γ, IL-17, IL-4 | Presumably many, including TNF-a, IFN-γ, IL-17 |
| Efficacy of immune modulation | Under investigation | 13 FDA-approved, disease-modifying drugs, moderate to high efficacy |