Cerebral small-vessel disease

The term cerebral small-vessel disease (SVD) encompasses a range of features visible on brain imaging, including lacunar infarction (from the Latin lacunae , a tiny hole, pit, or cavity), leukoaraiosis (from the Greek leuko , white, and araiosis , rarefaction), enlarged perivascular spaces (producing an appearance of etat crible , or cribriform state, from the Latin cribriform , perforated), and brain microbleeds. The investigative approach to cerebral SVD—including lacunar stroke—has been revolutionized in the last 4 decades by the advent of CT and MRI, which have overcome many of the limitations imposed by the old pathology-centered approach,1 whereby low early case-fatality rates necessitated most pathologic material being examined long after clinical symptoms had occurred. MRI in particular has markedly improved our ability to detect cerebral SVD in vivo, enabling detection of microangiopathic …