Advances on clinical features and definition of acute cerebral small vessel disease_West China Medical Journal

Authors：

YAN Yuying ,  WU Bo ,  ZHANG Shuting

Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

WU Bo, Email: dragonwb@126.com; ZHANG Shuting, Email: shutingzhangyang@qq.com

Keywords：

Acute cerebral small vessel disease; Lacunar stroke; Spontaneous intracerebral hemorrhage; Cerebral amyloid angiopathy

DOI：

10.7507/1002-0179.201909192

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Cerebral small vessel disease refers to a group of pathological processes, neuroimaging features, and clinical symptoms, with various etiologies that affect the small arteries, arterioles, venules, and capillaries of the brain. The onset of cerebral small vessel disease can be insidious. It has various symptoms, some of which can attack acutely. Acute cerebral small vessel disease is characterized by lacunar stroke and brain parenchymal hemorrhage. The latter mainly includes hypertensive hemorrhage and cerebral amyloid angiopathy. This article summarizes the research advances of acute cerebral small vessel disease from the aspects of pathogenesis, clinical manifestations, neuroimaging features, and treatment methods, discussing characteristics and clinical challenges.

Citation： YAN Yuying, WU Bo, ZHANG Shuting. Advances on clinical features and definition of acute cerebral small vessel disease. West China Medical Journal, 2019, 34(10): 1091-1095. doi: 10.7507/1002-0179.201909192 Copy

1.	Jokinen H, Kalska H, Ylikoski R, et al. Longitudinal cognitive decline in subcortical ischemic vascular disease - the LADIS study. Cerebrovasc Dis, 2009, 27(4): 384-391.
2.	Srikanth V, Beare R, Blizzard L, et al. Cerebral white matter lesions, gait, and the risk of incident falls a prospective population-based study. Stroke, 2009, 40(1): 175-180.
3.	Kuchel GA, Moscufo N, Guttmann CR, et al. Localization of brain white matter hyperintensities and urinary incontinence in community-dwelling older adults. J Gerontol A Biol Sci Med Sci, 2009, 64(8): 902-909.
4.	Herrmann LL, Le Masurier M, Ebmeier KP. White matter hyperintensities in late life depression: a systematic review. J Neurol Neurosurg Psychiatry, 2008, 79(6): 619-624.
5.	Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol, 2010, 9(7): 689-701.
6.	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑小血管病诊治共识. 中华神经科杂志, 2015, 48(10): 838-844.
7.	Wardlaw JM. What is a lacune?. Stroke, 2008, 39(11): 2921-2922.
8.	Wardlaw JM, Smith EE, Biessels GJ, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol, 2013, 12(8): 822-838.
9.	Norrving B. Long-term prognosis after lacunar infarction. Lancet Neurol, 2003, 2(4): 238-245.
10.	Caplan LR. Lacunar infarction and small vessel disease: pathology and pathophysiology. J Stroke, 2015, 17(1): 2-6.
11.	Gao S, Wang YJ, Xu AD, et al. Chinese ischemic stroke subclassification. Front Neurol, 2011, 2: 6.
12.	Gan R, Sacco RL, Kargman DE, et al. Testing the validity of the lacunar hypothesis: the Northern Manhattan Stroke Study experience. Neurology, 1997, 48(5): 1204-1211.
13.	Arboix A, Massons J, Garcia-Eroles L, et al. Clinical predictors of lacunar syndrome not due to lacunar infarction. BMC Neurol, 2010, 10: 31.
14.	Zhang ZH, Fan ZY, Kong QL, et al. Visualization of the lenticulostriate arteries at 3T using black-blood T1-weighted intracranial vessel wall imaging: comparison with 7T TOF-MRA. Eur Radiol, 2019, 29(3): 1452-1459.
15.	Cocho D, Belvis R, Marti-Fabregasa J, et al. Does thrombolysis benefit patients with lacunar syndrome?. Eur Neurol, 2006, 55(2): 70-73.
16.	Fluri F, Hatz F, Rutgers MP, et al. Intravenous thrombolysis in patients with stroke attributable to small artery occlusion. Eur J Neurol, 2010, 17(8): 1054-1060.
17.	Chen Y, Yan S, Xu M, et al. More extensive white matter hyperintensity is linked with higher risk of remote intracerebral hemorrhage after intravenous thrombolysis. Eur J Neurol, 2018, 25(2): 380.
18.	Charidimou A, Turc G, Oppenheim C, et al. Microbleeds, cerebral hemorrhage, and functional outcome after stroke thrombolysis. Stroke, 2017, 48(8): 2084-2090.
19.	Wang Y, Wang Y, Zhao X. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med, 2013, 58(4): 1140.
20.	Johnston SC, Easton JD, Farrant MA, et al. Clopidogrel and aspirin in acute ischemic stroke and High-Risk TIA. N Engl J Med, 2018, 379(3): 215-225.
21.	Kwok CS, Shoamanesh A, Copley HC, et al. Efficacy of antiplatelet therapy in secondary prevention following lacunar stroke pooled analysis of randomized trials. Stroke, 2015, 46(4): 1014.
22.	Group SS, Benavente OR, Coffey CS, et al. Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial. Lancet, 2013, 382(9891): 507-515.
23.	Qureshi AI, Tuhrim S, Broderick JP, et al. Spontaneous intracerebral hemorrhage. N Engl J Med, 2001, 344(19): 1450-1460.
24.	Linn J, Brueckmann H. Differential diagnosis of nontraumatic intracerebral hemorrhage. Klin Neuroradiol, 2009, 19(1): 45-61.
25.	Meretoja A, Strbian D, Putaala J, et al. Smash-U. Stroke, 2012, 43(10): 2592-2597.
26.	Lammie GA. Hypertensive cerebral small vessel disease and stroke. Brain Pathol, 2002, 12(3): 358-370.
27.	Attems J, Jellinger K, Thal DR, et al. Sporadic cerebral amyloid angiopathy. Neuropathol Appl Neurobiol, 2011, 37(1): 75-93.
28.	倪俊, 崔丽英. 临床医生应重视脑淀粉样发作. 中华神经科杂志, 2017, 50(3): 161-162.
29.	Linn J, Halpin A, Demaerel P, et al. Prevalence of superficial siderosis in patients with cerebral amyloid angiopathy. Neurology, 2010, 74(17): 1346-1350.
30.	Knudsen KA, Rosand J, Karluk D, et al. Clinical diagnosis of cerebral amyloid angiopathy: validation of the Boston criteria. Neurology, 2001, 56(4): 537-539.
31.	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑出血诊治指南(2014). 中华神经科杂志, 2015, 48(6): 435-444.
32.	Attems, J. Sporadic cerebral amyloid angiopathy: pathology, clinical implications, and possible pathomechanisms. Acta Neuropathol, 2005, 110(4): 345-359.
33.	Rosand J, Muzikansky A, Kumar A, et al. Spatial clustering of hemorrhages in probable cerebral amyloid angiopathy. Ann Neurol, 2005, 58(3): 459-462.
34.	Raposo N, Viguier A, Cuvinciuc V, et al. Cortical subarachnoid haemorrhage in the elderly: a recurrent event probably related to cerebral amyloid angiopathy. Eur J Neurol, 2011, 18(4): 597-603.
35.	Charidimou A, Peeters A, Fox Z, et al. Spectrum of transient focal neurological episodes in cerebral amyloid angiopathy: multicentre magnetic resonance imaging cohort study and meta-analysis. Stroke, 2012, 43(9): 2324-2330.
36.	Charidimou A, Imaizumi T, Moulin S, et al. Brain hemorrhage recurrence, small vessel disease type, and cerebral microbleeds: a meta-analysis. Neurology, 2017, 89(8): 820-829.
37.	Anderson CS, Heeley E, Huang Y, et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med, 2013, 368(25): 2355-2365.
38.	Qureshi AI, Palesch YY, Barsan WG, et al. Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med, 2016, 375(11): 1033-1043.

1. Jokinen H, Kalska H, Ylikoski R, et al. Longitudinal cognitive decline in subcortical ischemic vascular disease - the LADIS study. Cerebrovasc Dis, 2009, 27(4): 384-391.
2. Srikanth V, Beare R, Blizzard L, et al. Cerebral white matter lesions, gait, and the risk of incident falls a prospective population-based study. Stroke, 2009, 40(1): 175-180.
3. Kuchel GA, Moscufo N, Guttmann CR, et al. Localization of brain white matter hyperintensities and urinary incontinence in community-dwelling older adults. J Gerontol A Biol Sci Med Sci, 2009, 64(8): 902-909.
4. Herrmann LL, Le Masurier M, Ebmeier KP. White matter hyperintensities in late life depression: a systematic review. J Neurol Neurosurg Psychiatry, 2008, 79(6): 619-624.
5. Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol, 2010, 9(7): 689-701.
6. 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑小血管病诊治共识. 中华神经科杂志, 2015, 48(10): 838-844.
7. Wardlaw JM. What is a lacune?. Stroke, 2008, 39(11): 2921-2922.
8. Wardlaw JM, Smith EE, Biessels GJ, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol, 2013, 12(8): 822-838.
9. Norrving B. Long-term prognosis after lacunar infarction. Lancet Neurol, 2003, 2(4): 238-245.
10. Caplan LR. Lacunar infarction and small vessel disease: pathology and pathophysiology. J Stroke, 2015, 17(1): 2-6.
11. Gao S, Wang YJ, Xu AD, et al. Chinese ischemic stroke subclassification. Front Neurol, 2011, 2: 6.
12. Gan R, Sacco RL, Kargman DE, et al. Testing the validity of the lacunar hypothesis: the Northern Manhattan Stroke Study experience. Neurology, 1997, 48(5): 1204-1211.
13. Arboix A, Massons J, Garcia-Eroles L, et al. Clinical predictors of lacunar syndrome not due to lacunar infarction. BMC Neurol, 2010, 10: 31.
14. Zhang ZH, Fan ZY, Kong QL, et al. Visualization of the lenticulostriate arteries at 3T using black-blood T1-weighted intracranial vessel wall imaging: comparison with 7T TOF-MRA. Eur Radiol, 2019, 29(3): 1452-1459.
15. Cocho D, Belvis R, Marti-Fabregasa J, et al. Does thrombolysis benefit patients with lacunar syndrome?. Eur Neurol, 2006, 55(2): 70-73.
16. Fluri F, Hatz F, Rutgers MP, et al. Intravenous thrombolysis in patients with stroke attributable to small artery occlusion. Eur J Neurol, 2010, 17(8): 1054-1060.
17. Chen Y, Yan S, Xu M, et al. More extensive white matter hyperintensity is linked with higher risk of remote intracerebral hemorrhage after intravenous thrombolysis. Eur J Neurol, 2018, 25(2): 380.
18. Charidimou A, Turc G, Oppenheim C, et al. Microbleeds, cerebral hemorrhage, and functional outcome after stroke thrombolysis. Stroke, 2017, 48(8): 2084-2090.
19. Wang Y, Wang Y, Zhao X. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med, 2013, 58(4): 1140.
20. Johnston SC, Easton JD, Farrant MA, et al. Clopidogrel and aspirin in acute ischemic stroke and High-Risk TIA. N Engl J Med, 2018, 379(3): 215-225.
21. Kwok CS, Shoamanesh A, Copley HC, et al. Efficacy of antiplatelet therapy in secondary prevention following lacunar stroke pooled analysis of randomized trials. Stroke, 2015, 46(4): 1014.
22. Group SS, Benavente OR, Coffey CS, et al. Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial. Lancet, 2013, 382(9891): 507-515.
23. Qureshi AI, Tuhrim S, Broderick JP, et al. Spontaneous intracerebral hemorrhage. N Engl J Med, 2001, 344(19): 1450-1460.
24. Linn J, Brueckmann H. Differential diagnosis of nontraumatic intracerebral hemorrhage. Klin Neuroradiol, 2009, 19(1): 45-61.
25. Meretoja A, Strbian D, Putaala J, et al. Smash-U. Stroke, 2012, 43(10): 2592-2597.
26. Lammie GA. Hypertensive cerebral small vessel disease and stroke. Brain Pathol, 2002, 12(3): 358-370.
27. Attems J, Jellinger K, Thal DR, et al. Sporadic cerebral amyloid angiopathy. Neuropathol Appl Neurobiol, 2011, 37(1): 75-93.
28. 倪俊, 崔丽英. 临床医生应重视脑淀粉样发作. 中华神经科杂志, 2017, 50(3): 161-162.
29. Linn J, Halpin A, Demaerel P, et al. Prevalence of superficial siderosis in patients with cerebral amyloid angiopathy. Neurology, 2010, 74(17): 1346-1350.
30. Knudsen KA, Rosand J, Karluk D, et al. Clinical diagnosis of cerebral amyloid angiopathy: validation of the Boston criteria. Neurology, 2001, 56(4): 537-539.
31. 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑出血诊治指南(2014). 中华神经科杂志, 2015, 48(6): 435-444.
32. Attems, J. Sporadic cerebral amyloid angiopathy: pathology, clinical implications, and possible pathomechanisms. Acta Neuropathol, 2005, 110(4): 345-359.
33. Rosand J, Muzikansky A, Kumar A, et al. Spatial clustering of hemorrhages in probable cerebral amyloid angiopathy. Ann Neurol, 2005, 58(3): 459-462.
34. Raposo N, Viguier A, Cuvinciuc V, et al. Cortical subarachnoid haemorrhage in the elderly: a recurrent event probably related to cerebral amyloid angiopathy. Eur J Neurol, 2011, 18(4): 597-603.
35. Charidimou A, Peeters A, Fox Z, et al. Spectrum of transient focal neurological episodes in cerebral amyloid angiopathy: multicentre magnetic resonance imaging cohort study and meta-analysis. Stroke, 2012, 43(9): 2324-2330.
36. Charidimou A, Imaizumi T, Moulin S, et al. Brain hemorrhage recurrence, small vessel disease type, and cerebral microbleeds: a meta-analysis. Neurology, 2017, 89(8): 820-829.
37. Anderson CS, Heeley E, Huang Y, et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med, 2013, 368(25): 2355-2365.
38. Qureshi AI, Palesch YY, Barsan WG, et al. Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med, 2016, 375(11): 1033-1043.

West China Medical Journal

Advances on clinical features and definition of acute cerebral small vessel disease

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content