Prognostic Impact of Cerebral Small Vessel Disease on Stroke Outcome

Beom Joon Kim, Seung-Hoon Lee, Beom Joon Kim, Seung-Hoon Lee

Abstract

Cerebral small vessel disease (SVD), which includes white matter hyperintensities (WMHs), silent brain infarction (SBI), and cerebral microbleeds (CMBs), develops in a conjunction of cumulated injuries to cerebral microvascular beds, increased permeability of blood-brain barriers, and chronic oligemia. SVD is easily detected by routine neuroimaging modalities such as brain computed tomography or magnetic resonance imaging. Research has revealed that the presence of SVD markers may increase the risk of future vascular events as well as deteriorate functional recovery and neurocognitive trajectories after stroke, and such an association could also be applied to hemorrhagic stroke survivors. Currently, the specific mechanistic processes leading to the development and manifestation of SVD risk factors are unknown, and further studies with novel methodological tools are warranted. In this review, recent studies regarding the prognostic impact of WMHs, SBI, and CMBs on stroke survivors and briefly summarize the pathophysiological concepts underlying the manifestation of cerebral SVD.

Keywords: Cerebral microbleed; Outcome; Prognosis; Silent brain infarction; Small vessel disease; White matter hyperintensity.

Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Figure 1. Prolonged exposure to aging, vascular…
Figure 1. Prolonged exposure to aging, vascular risk factors, and unknown offenders may provoke various changes in the brain tissue and cerebral vascular bed, including basement membrane and blood-brain barrier function, which also causes elongation of cerebral capillaries and increased permeability of the barrier. This leads to heightened intraparenchymal inflammation due to the oxidative stress caused by extravasation of blood-derived components over the BBB, modest but chronic cerebral hypoperfusion, and a resultant decrease in cerebral protein synthesis.
Figure 2. The overall process of endothelial…
Figure 2. The overall process of endothelial injury, permeable BBB, structural derangement of microvascular beds, parenchymal inflammation, and decreased protein synthesis will determine the individual vulnerability to future profound or minute insults from various noxious stimuli. Cerebral SVD, a manifestation of the pathologic chain of injuries, will have its role as a marker for individual susceptibility.

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