Neuroimaging Sciences, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, UK.
Lancet Neurol. 2013 May;12(5):483-97. doi: 10.1016/S1474-4422(13)70060-7.
The term cerebral small vessel disease (SVD) describes a range of neuroimaging, pathological, and associated clinical features. Clinical features range from none, to discrete focal neurological symptoms (eg, stroke), to insidious global neurological dysfunction and dementia. The burden on public health is substantial. The pathogenesis of SVD is largely unknown. Although the pathological processes leading to the arteriolar disease are associated with vascular risk factors and are believed to result from an intrinsic cerebral arteriolar occlusive disease, little is known about how these processes result in brain disease, how SVD lesions contribute to neurological or cognitive symptoms, and the association with risk factors. Pathology often shows end-stage disease, which makes identification of the earliest stages difficult. Neuroimaging provides considerable insights; although the small vessels are not easily seen themselves, the effects of their malfunction on the brain can be tracked with detailed brain imaging. We discuss potential mechanisms, detectable with neuroimaging, that might better fit the available evidence and provide testable hypotheses for future study.
脑小血管病（SVD）一词描述了一系列神经影像学、病理学和相关临床特征。临床特征从无到有，包括离散的局灶性神经症状（如中风），到隐匿性的全面神经功能障碍和痴呆。它给公共卫生带来了巨大负担。SVD 的发病机制在很大程度上尚不清楚。尽管导致小血管疾病的病理过程与血管危险因素有关，并被认为是由于内在的脑小动脉闭塞性疾病所致，但人们对这些过程如何导致脑疾病、SVD 病变如何导致神经或认知症状以及与危险因素的关系知之甚少。病理学通常显示终末期疾病，这使得识别早期阶段变得困难。神经影像学提供了大量的见解；尽管小血管本身不容易被看到，但可以通过详细的脑部成像来跟踪它们功能障碍对大脑的影响。我们讨论了潜在的机制，这些机制可以通过神经影像学检测到，这些机制可能更符合现有证据，并为未来的研究提供可检验的假设。
