What is Small Vessel Disease?

Small vessel disease is commonly seen on brain scans. At the age of 50, some people have some evidence of small vessel disease, and at the age of 80, most people have it. Most people do not have symptoms from cerebral small vessel disease, but some do. The symptoms it can lead to include:  

• Ischaemic stroke: A blocked small blood vessel leads to a small area of brain damage. This is called a ‘lacunar stroke'. Lacunar stroke can lead to sudden weakness or loss of sensation down one side of the body, clumsiness, double vision and speech disturbance. Most people with SVD do not develop a stroke.
• Intracerebral haemorrhage: A burst small blood vessel causes bleeding in the brain and results in symptoms. This is called a ‘haemorrhagic stroke’. Intracerebral haemorrhage (or stroke due to bleeding) can lead to sudden weakness, speech, and vision problems. They can be very severe but are rare and most people with SVD do not develop a haemorrhage.
• Mild cognitive impairment or dementia: Brain damage associated with small vessel disease can lead to progressive slowness of thought and memory problems. This can range from mild cognitive impairment, i.e. cognitive problems that do not impact on day-to-day activities, to dementia, which affects activities of daily living. Most people with SVD do not develop mild cognitive impairment. 
• If small vessel disease is the only change leading to dementia, it is called ‘vascular dementia’; if small vessel disease coexists with other brain changes, it is called ‘mixed dementia’. Most people with small vessel disease do not develop dementia. People who have mild cognitive impairment do not always develop dementia.  
• Other symptoms: Some people have symptoms that can be due to small vessel disease that are hard to diagnose and often have other causes, like slowness of walking, poor balance, problems with mood, and poor bladder control. 

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The cause of small vessel disease is not precisely understood. We do know that people who are older, have higher blood pressure, or have diabetes are more likely to develop small vessel disease. Sometimes (although rarely) small vessel disease has a genetic cause, which usually runs in families.   

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Small vessel disease is usually detected on a brain scan performed for reasons unrelated to small vessel disease symptoms, although sometimes it is detected on scans performed to investigate stroke or memory problems. Brain scans are either done with Magnetic Resonance Imaging (MRI), which uses magnetic fields, or Computed Tomography (CT), which uses X-rays. 

Researchers are working to find the best ways to prevent small vessel disease. 

Lifestyle changes such as maintaining a healthy diet, regular exercise, controlling blood pressure and diabetes, and not smoking can reduce the risk. 

To learn more, here are some recommendations from the British Heart Foundation on: 

• Smoking
• High cholesterol
• High blood pressure
• Diabetes
• Obesity
• Physical inactivity

Lead a healthy lifestyle: keep your weight down, take regular exercise, avoid smoking and eat a healthy diet without adding salt. Get your blood pressure and blood sugar checked regularly, and if you think you may have high blood pressure or symptoms of diabetes. The brain and body are very closely connected, so improvements in your general health are likely to improve your brain health.

Professor Joanna Wardlaw

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There are guidelines for medical professionals here [INSERT LINK TO ESO GUIDELINES, STRIVE etc]