Cerebral small vessel disease (CSVD)

Cerebral small vessel disease (CSVD) encompasses a spectrum of pathological changes affecting the perforating arteries, arterioles, capillaries and venules of the brain, resulting in a characteristic constellation of neuroimaging findings: white matter hyperintensities, lacunar infarcts, enlarged perivascular spaces, microbleeds and cortical superficial siderosis. Hypertension is the dominant modifiable risk factor; additional contributors include diabetes, dyslipidaemia, smoking and genetic variants such as NOTCH3 mutations in CADASIL. CSVD accounts for approximately 25% of all strokes and is the most common cause of vascular cognitive impairment, with cumulative lesion burden correlating with executive dysfunction, gait disturbance, depression and progression to vascular dementia. Currently there is no disease-modifying pharmacotherapy specific to CSVD; blood pressure control remains the most robustly evidence-based intervention for slowing lesion accrual.