Skip to main content

Advertisement

SpringerLink
Log in

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

  • Minireview
  • Published:
Neuroscience Bulletin Aims and scope Submit manuscript

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.

摘要

小血맜病与慢性脑循环障碍相关, 占缺血性卒中的20%–30%, 也是大部分脑出血和脑病的病因所在。 与小血맜病相关的疾病包括Binswanger 病、 多发小灶中风和微出血, 这些疾病在老年人中的发病率极高, 且往往导致认知减退或血맜性痴呆、 步态和平衡障碍、 情绪低落、 尿失禁等。 小血맜病相关性脑病预示着老年人跌倒、 致残和死亡的几率增加, 因此其临床特点和病理生理机制正日益受到关注。 本文对脑小血맜病的危险因素、 发病机制、 病理以及临床表现作一综述。

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Zubkov AY, Uschmann H, Rabinstein AA. Rate of arterial occlusion in patients with acute ischemic stroke. Neurol Res 2008, 30(8): 835–838.

    Article  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.

    CAS  PubMed  Google Scholar 

  3. Nitkunan A, Charlton RA, Barrick TR, McIntyre DJ, Howe FA, Markus HS. Reduced N-acetylaspartate is consistent with axonal dysfunction in cerebral small vessel disease. NMR Biomed 2009, 22(3): 285–291.

    Article  CAS  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.

    Article  PubMed  Google Scholar 

  5. Fiehler J. Cerebral microbleeds: old leaks and new haemorrhages. Int J Stroke 2006, 1(3): 122–130.

    Article  PubMed  Google Scholar 

  6. Greenberg SM, Vernooij MW, 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.

    Article  PubMed  Google Scholar 

  7. Küker W. Imaging of cerebral vasculitis. Int J Stroke 2007, 2(3): 184–190.

    Article  PubMed  Google Scholar 

  8. Black S, Gao F, Bilbao J. Understanding white matter disease. Imaging-pathological correlations in Vascular Cognitive Impairment. Stroke 2009, 40(3 Suppl): S48–52.

    Google Scholar 

  9. Hendrikse J, Zwanenburg JJ, 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.

    Article  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.

    Article  PubMed  Google Scholar 

  12. Rapp JH, Pan XM, 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.

    Article  CAS  PubMed  Google Scholar 

  13. Rao R, Tah V, Casas JP, 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.

    Article  PubMed  Google Scholar 

  14. Staekenborg SS, van Straaten EC, van der Flier WM, 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.

    Article  CAS  PubMed  Google Scholar 

  15. Rosenberg GA. Inflammation and white matter damage in Vascular Cognitive Impairment. Stroke 2009, 40(3 Suppl): S20–23

    Article  PubMed  Google Scholar 

  16. Wen YD, Zhang HL, Qin ZH. Inflammatory mechanism in ischemic neuronal injury. Neurosci Bull 2006, 22(3): 171–182.

    CAS  PubMed  Google Scholar 

  17. Silbert LC, Nelson C, Howieson DB, Moore MM, Kaye JA. Impact of white matter hyperintensity volume progression on rate of cognitive and motor decline. Neurology 2008, 71(2): 108–113.

    Article  CAS  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.

    CAS  PubMed  Google Scholar 

  19. Rosano C, Newman AB, Katz R, Hirsch CH, Kuller LH. 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.

    Article  PubMed  Google Scholar 

  20. Waite LM, Grayson DA, Piguet O, Creasey H, Bennett HP, Broe GA. 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.

    Article  PubMed  Google Scholar 

  21. Rosano C, Brach J, Longstreth Jr WT, Newman AB. Quantitative measures of gait characteristics indicate prevalence of underlying subclinical structural brain abnormalities in high-functioning older adults. Neuroepidemiology 2006, 26(1): 52–60.

    Article  PubMed  Google Scholar 

  22. Acharya HJ, Bouchard TP, Emery DJ, Camicioli RM. Axial signs and magnetic resonance imaging correlates in Parkinson’s disease. Can J Neurol Sci 2007, 34(1): 56–61.

    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.

    Article  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.

    Article  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.

    Article  CAS  PubMed  Google Scholar 

  26. Nadeau SE. Gait apraxia: further clues to localization. Eur Neurol 2007, 58(3): 142–145.

    Article  PubMed  Google Scholar 

  27. Denays R, Tondeur M, Noël P, Ham HR. Bilateral cerebral mediofrontal hypoactivity in Tc-99m HMPAO SPECT imaging. Clin Nucl Med 1994, 19(10): 873–876.

    Article  CAS  PubMed  Google Scholar 

  28. Wolfson L, Wei X, Hall CB, Panzer V, Wakefield D, Benson RR, et al. Accrual of MRI white matter abnormalities in elderly with normal and impaired mobility. J Neurol Sci. 2005, 232(1–2): 23–27.

    Article  PubMed  Google Scholar 

  29. Sibon I, Fenelon G, Quinn NP, Tison F. Vascular parkinsonism. J Neurol 2004, 251(5): 513–524.

    Article  PubMed  Google Scholar 

  30. da Silva EG, Viana MA, Quagliato EM. Vascular parkinsonism: analysis of seven cases. Arq Neuropsiquiatr 2006, 64(3A): 568–571.

    PubMed  Google Scholar 

  31. Factor SA. The clinical spectrum of freezing of gait in atypical parkinsonism. Mov Disord 2008, 23(Suppl 2): S431–438.

    PubMed  Google Scholar 

  32. Rektor I, Rektorová I, Kubová D. Vascular parkinsonism-an update. J Neurol Sci 2006, 248(1–2): 185–191.

    Article  PubMed  Google Scholar 

  33. Zijlmans JC, Daniel SE, Hughes AJ, Révész T, Lees AJ. Clinicopathological investigation of vascular parkinsonism, including clinical criteria for diagnosis. Mov Disord 2004, 19(6): 630–640.

    Article  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.

    Article  CAS  PubMed  Google Scholar 

  35. Kuo HK, Lipsitz LA. Cerebral white matter changes and geriatric syndromes: is there a link? J Gerontol A Biol Sci Med Sci 2004, 59(8): 818–826.

    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.

    PubMed  Google Scholar 

  37. Román GC, Royall DR. Executive control function: a rational basis for the diagnosis of vascular dementia. Alzheimer Dis Assoc Disord 1999, 13(Suppl 3): S69–80.

    Article  PubMed  Google Scholar 

  38. Chen Y, Chen X, Mok VC, Lam WW, Wong KS, Tang WK. Poststroke depression in patients with small subcortical infarcts. Clin Neurol Neurosurg 2009, 111(3): 256–260.

    Article  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.

    Article  CAS  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.

    Article  PubMed  Google Scholar 

  41. Huynh TJ, Murphy B, Pettersen JA, Tu H, Sahlas DJ, Zhang L, et al. CT perfusion quantification of small-vessel ischemic severity. AJNR Am J Neuroradiol 2008, 29(10): 1831–1836.

    Article  CAS  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.

    Article  PubMed  Google Scholar 

  43. Bugalho P, Viana-Baptista M, Jordão C, Secca MF, Ferro JM. 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.

    Article  CAS  PubMed  Google Scholar 

  44. Staals J, Pieters BM, Knottnerus IL, Rouhl RP, van Oostenbrugge RJ, Delanghe JR, et al. Haptoglobin polymorphism and lacunar stroke. Curr Neurovasc Res 2008, 5(3): 153–158.

    Article  CAS  PubMed  Google Scholar 

  45. Pruissen DM, Kappelle LJ, Rosendaal FR, Rouhl RP, van Oostenbrugge RJ, Delanghe JR. Prothrombotic gene variation in patients with large and small vessel disease. Neuroepidemiology 2008, 31(2): 89–92.

    Article  PubMed  Google Scholar 

  46. Quattrocolo G, Leombruni S, Vaula G, Bergui M, Riva A, Bradac GB, et al. Autosomal dominant late-onset leukoencephalopathy. Clinical report of a new Italian family. Eur Neurol 1997, 37(1): 53–61.

    CAS  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.

    Article  CAS  PubMed  Google Scholar 

  48. Huang Z, Jacewicz M, Pfeiffer RF. Anticardiolipin antibody in vascular parkinsonism. Mov Disord 2002, 17(5): 992–997.

    Article  PubMed  Google Scholar 

  49. Lee SJ, Kim JS, Lee KS, An JY, Kim W, Kim YI, 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.

    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.

    Article  PubMed  Google Scholar 

  51. Khan U, Crossley C, Kalra L, Rudd A, Wolfe CD, 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.

    Article  CAS  PubMed  Google Scholar 

  52. Huber JD. Diabetes, cognitive function, and the blood-brain barrier. Curr Pharm Des 2008, 14(16): 1594–1600.

    Article  CAS  PubMed  Google Scholar 

  53. Sachidanandam K, Hutchinson JR, Elgebaly MM, Mezzetti EM, Wang MH, 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.

    Article  CAS  PubMed  Google Scholar 

  54. Tomimoto H, Ihara M, Wakita H, Ohtani R, Lin JX, 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.

    Article  CAS  PubMed  Google Scholar 

  55. Utter S, Tamboli IY, Walter J, Upadhaya AR, Birkenmeier G, Pietrzik CU, 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.

    Article  CAS  PubMed  Google Scholar 

  56. Bradley WG Jr, Whittemore AR, Watanabe AS, Davis SJ, Teresi LM, 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.

    PubMed  Google Scholar 

  57. Choi JC. 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.

    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.

    CAS  Google Scholar 

  59. Koennecke HC. Cerebral microbleeds on MRI: prevalence, associations, and potential clinical implications. Neurology 2006

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Wei Fang Brain Hospital, Weifang, 261021, China

    Ai-Juan Zhang  (张爱娟) & Xin-Jun Yu  (于新军)

  2. Weifang Medical College, Weifang, 261042, China

    Mei Wang  (王梅)

Authors
  1. Ai-Juan Zhang  (张爱娟)
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xin-Jun Yu  (于新军)
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mei Wang  (王梅)
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ai-Juan Zhang  (张爱娟).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhang, AJ., Yu, XJ. & Wang, M. The clinical manifestations and pathophysiology of cerebral small vessel disease. Neurosci. Bull. 26, 257–264 (2010). https://doi.org/10.1007/s12264-010-1210-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12264-010-1210-y

Keywords

关键词

Search

Navigation