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Arteriolosclerosis
Karen L. Salzman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Small vessel disease, microvascular disease, microangiopathy
              • Imaging correlate = leukoaraiosis or periventricular leukoencephalopathy
            • Definitions

              • Sclerosis of small-sized arteries (arterioles)
                • Commonly from chronic HTN, hypercholesterolemia, &/or diabetes mellitus (DM)
                • May lead to vascular dementia

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Angiographic Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Gurol ME et al: Advanced neuroimaging to unravel mechanisms of cerebral small vessel diseases. Stroke. 51(1):29-37, 2020
                                              2. Hase Y et al: Small vessel disease pathological changes in neurodegenerative and vascular dementias concomitant with autonomic dysfunction. Brain Pathol. 30(1):191-202, 2020
                                              3. Marini S et al: Genetics of cerebral small vessel disease. Stroke. 51(1):12-20, 2020
                                              4. Mistry EA et al: White matter disease and outcomes of mechanical thrombectomy for acute ischemic stroke. AJNR Am J Neuroradiol. 41(4):639-44, 2020
                                              5. Patel KP et al: Multimodality imaging of dementia: clinical importance and role of integrated anatomic and molecular imaging. Radiographics. 40(1):200-22, 2020
                                              6. Shindo A et al: Clinical features and experimental models of cerebral small vessel disease. Front Aging Neurosci. 12:109, 2020
                                              7. Alosco ML et al: Association of white matter rarefaction, arteriolosclerosis, and Tau with dementia in chronic traumatic encephalopathy. JAMA Neurol. 76(11):1298-1308, 2019
                                              8. Hannawi Y et al: Hypertension Is associated with white matter disruption in apparently healthy middle-aged individuals. AJNR Am J Neuroradiol. 39(12):2243-8, 2018
                                              9. Xie Y et al: White matter microstructural abnormalities in type 2 diabetes mellitus: A diffusional turtosis imaging analysis. AJNR Am J Neuroradiol. 38(3):617-25, 2017
                                              10. Kitagawa K et al: Association between carotid stenosis or lacunar infarction and incident dementia in patients with vascular risk factors. Eur J Neurol. 22(1):187-92, 2015
                                              11. Bertelson JA et al: Neuroimaging of dementia. Neurol Clin. 32(1):59-93, 2014
                                              12. Bridges LR et al: Blood-brain barrier dysfunction and cerebral small vessel disease (arteriolosclerosis) in brains of older people. J Neuropathol Exp Neurol. 73(11):1026-33, 2014
                                              13. Craggs LJ et al: Microvascular pathology and morphometrics of sporadic and hereditary small vessel diseases of the brain. Brain Pathol. 24(5):495-509, 2014
                                              14. Janaway BM et al: Brain haemosiderin in older people: pathological evidence for an ischaemic origin of magnetic resonance imaging (MRI) microbleeds. Neuropathol Appl Neurobiol. 40(3):258-69, 2014
                                              15. Neltner JH et al: Arteriolosclerosis that affects multiple brain regions is linked to hippocampal sclerosis of ageing. Brain. 137(Pt 1):255-67, 2014
                                              16. Roh JH et al: Recent updates on subcortical ischemic vascular dementia. J Stroke. 16(1):18-26, 2014
                                              17. Erten-Lyons D et al: Neuropathologic basis of white matter hyperintensity accumulation with advanced age. Neurology. 81(11):977-83, 2013
                                              18. Schreiber S et al: Blood brain barrier breakdown as the starting point of cerebral small vessel disease? - New insights from a rat model. Exp Transl Stroke Med. 5(1):4, 2013
                                              19. Zheng L et al: Cerebral atherosclerosis is associated with cystic infarcts and microinfarcts but not Alzheimer pathologic changes. Stroke. 44(10):2835-41, 2013
                                              20. Smith EE et al: Cerebral microinfarcts: the invisible lesions. Lancet Neurol. 11(3):272-82, 2012
                                              21. Thal DR et al: Vascular dementia: different forms of vessel disorders contribute to the development of dementia in the elderly brain. Exp Gerontol. 47(11):816-24, 2012
                                              22. Wallin A et al: Characteristic clinical presentation and CSF biomarker pattern in cerebral small vessel disease. J Neurol Sci. 322(1-2):192-6, 2012
                                              23. Kimberly WT et al: Silent ischemic infarcts are associated with hemorrhage burden in cerebral amyloid angiopathy. Neurology. 72(14):1230-5, 2009
                                              24. Vernooij MW et al: Use of antithrombotic drugs and the presence of cerebral microbleeds: the Rotterdam Scan Study. Arch Neurol. 66(6):714-20, 2009
                                              25. Matsusue E et al: White matter changes in elderly people: MR-pathologic correlations. Magn Reson Med Sci. 5(2):99-104, 2006
                                              26. Viswanathan A et al: Cerebral microhemorrhage. Stroke. 37(2):550-5, 2006
                                              27. Yip AG et al: APOE, vascular pathology, and the AD brain. Neurology. 65(2):259-65, 2005
                                              28. Arboix A et al: New concepts in lacunar stroke etiology: the constellation of small-vessel arterial disease. Cerebrovasc Dis. 17 Suppl 1:58-62, 2004
                                              29. Gass A et al: Diffusion-weighted MRI for the "small stuff": the details of acute cerebral ischaemia. Lancet Neurol. 3(1):39-45, 2004
                                              30. Lee SH et al: Comparative analysis of the spatial distribution and severity of cerebral microbleeds and old lacunes. J Neurol Neurosurg Psychiatry. 75(3):423-7, 2004
                                              31. van Straaten EC et al: Operational definitions for the NINDS-AIREN criteria for vascular dementia: an interobserver study. Stroke. 34(8):1907-12, 2003
                                              32. Cohen RA et al: The relationship of subcortical MRI hyperintensities and brain volume to cognitive function in vascular dementia. J Int Neuropsychol Soc. 8(6):743-52, 2002
                                              33. Schmidt R et al: Evolution of white matter lesions. Cerebrovasc Dis. 13 Suppl 2:16-20, 2002
                                              34. Schmidt R et al: Risk factors and progression of small vessel disease-related cerebral abnormalities. J Neural Transm Suppl. (62):47-52, 2002
                                              35. Schmidt R et al: The natural course of MRI white matter hyperintensities. J Neurol Sci. 203-204:253-7, 2002
                                              36. Udaka F et al: White matter lesions and dementia: MRI-pathological correlation. Ann N Y Acad Sci. 977:411-5, 2002
                                              37. van Den Boom R et al: Subcortical lacunar lesions: an MR imaging finding in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. Radiology. 224(3):791-6, 2002
                                              38. Varma AR et al: Diagnostic value of high signal abnormalities on T2 weighted MRI in the differentiation of Alzheimer's, frontotemporal and vascular dementias. Acta Neurol Scand. 105(5):355-64, 2002
                                              39. Auer DP et al: Differential lesion patterns in CADASIL and sporadic subcortical arteriosclerotic encephalopathy: MR imaging study with statistical parametric group comparison. Radiology. 218(2):443-51, 2001
                                              40. Wahlund LO et al: A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke. 32(6):1318-22, 2001
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Synonyms

                                                          • Small vessel disease, microvascular disease, microangiopathy
                                                          • Imaging correlate = leukoaraiosis or periventricular leukoencephalopathy
                                                        • Definitions

                                                          • Sclerosis of small-sized arteries (arterioles)
                                                            • Commonly from chronic HTN, hypercholesterolemia, &/or diabetes mellitus (DM)
                                                            • May lead to vascular dementia

                                                        IMAGING

                                                        • General Features

                                                          • CT Findings

                                                            • MR Findings

                                                              • Angiographic Findings

                                                                • Nuclear Medicine Findings

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Staging, Grading, & Classification

                                                                          • Gross Pathologic & Surgical Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Gurol ME et al: Advanced neuroimaging to unravel mechanisms of cerebral small vessel diseases. Stroke. 51(1):29-37, 2020
                                                                                          2. Hase Y et al: Small vessel disease pathological changes in neurodegenerative and vascular dementias concomitant with autonomic dysfunction. Brain Pathol. 30(1):191-202, 2020
                                                                                          3. Marini S et al: Genetics of cerebral small vessel disease. Stroke. 51(1):12-20, 2020
                                                                                          4. Mistry EA et al: White matter disease and outcomes of mechanical thrombectomy for acute ischemic stroke. AJNR Am J Neuroradiol. 41(4):639-44, 2020
                                                                                          5. Patel KP et al: Multimodality imaging of dementia: clinical importance and role of integrated anatomic and molecular imaging. Radiographics. 40(1):200-22, 2020
                                                                                          6. Shindo A et al: Clinical features and experimental models of cerebral small vessel disease. Front Aging Neurosci. 12:109, 2020
                                                                                          7. Alosco ML et al: Association of white matter rarefaction, arteriolosclerosis, and Tau with dementia in chronic traumatic encephalopathy. JAMA Neurol. 76(11):1298-1308, 2019
                                                                                          8. Hannawi Y et al: Hypertension Is associated with white matter disruption in apparently healthy middle-aged individuals. AJNR Am J Neuroradiol. 39(12):2243-8, 2018
                                                                                          9. Xie Y et al: White matter microstructural abnormalities in type 2 diabetes mellitus: A diffusional turtosis imaging analysis. AJNR Am J Neuroradiol. 38(3):617-25, 2017
                                                                                          10. Kitagawa K et al: Association between carotid stenosis or lacunar infarction and incident dementia in patients with vascular risk factors. Eur J Neurol. 22(1):187-92, 2015
                                                                                          11. Bertelson JA et al: Neuroimaging of dementia. Neurol Clin. 32(1):59-93, 2014
                                                                                          12. Bridges LR et al: Blood-brain barrier dysfunction and cerebral small vessel disease (arteriolosclerosis) in brains of older people. J Neuropathol Exp Neurol. 73(11):1026-33, 2014
                                                                                          13. Craggs LJ et al: Microvascular pathology and morphometrics of sporadic and hereditary small vessel diseases of the brain. Brain Pathol. 24(5):495-509, 2014
                                                                                          14. Janaway BM et al: Brain haemosiderin in older people: pathological evidence for an ischaemic origin of magnetic resonance imaging (MRI) microbleeds. Neuropathol Appl Neurobiol. 40(3):258-69, 2014
                                                                                          15. Neltner JH et al: Arteriolosclerosis that affects multiple brain regions is linked to hippocampal sclerosis of ageing. Brain. 137(Pt 1):255-67, 2014
                                                                                          16. Roh JH et al: Recent updates on subcortical ischemic vascular dementia. J Stroke. 16(1):18-26, 2014
                                                                                          17. Erten-Lyons D et al: Neuropathologic basis of white matter hyperintensity accumulation with advanced age. Neurology. 81(11):977-83, 2013
                                                                                          18. Schreiber S et al: Blood brain barrier breakdown as the starting point of cerebral small vessel disease? - New insights from a rat model. Exp Transl Stroke Med. 5(1):4, 2013
                                                                                          19. Zheng L et al: Cerebral atherosclerosis is associated with cystic infarcts and microinfarcts but not Alzheimer pathologic changes. Stroke. 44(10):2835-41, 2013
                                                                                          20. Smith EE et al: Cerebral microinfarcts: the invisible lesions. Lancet Neurol. 11(3):272-82, 2012
                                                                                          21. Thal DR et al: Vascular dementia: different forms of vessel disorders contribute to the development of dementia in the elderly brain. Exp Gerontol. 47(11):816-24, 2012
                                                                                          22. Wallin A et al: Characteristic clinical presentation and CSF biomarker pattern in cerebral small vessel disease. J Neurol Sci. 322(1-2):192-6, 2012
                                                                                          23. Kimberly WT et al: Silent ischemic infarcts are associated with hemorrhage burden in cerebral amyloid angiopathy. Neurology. 72(14):1230-5, 2009
                                                                                          24. Vernooij MW et al: Use of antithrombotic drugs and the presence of cerebral microbleeds: the Rotterdam Scan Study. Arch Neurol. 66(6):714-20, 2009
                                                                                          25. Matsusue E et al: White matter changes in elderly people: MR-pathologic correlations. Magn Reson Med Sci. 5(2):99-104, 2006
                                                                                          26. Viswanathan A et al: Cerebral microhemorrhage. Stroke. 37(2):550-5, 2006
                                                                                          27. Yip AG et al: APOE, vascular pathology, and the AD brain. Neurology. 65(2):259-65, 2005
                                                                                          28. Arboix A et al: New concepts in lacunar stroke etiology: the constellation of small-vessel arterial disease. Cerebrovasc Dis. 17 Suppl 1:58-62, 2004
                                                                                          29. Gass A et al: Diffusion-weighted MRI for the "small stuff": the details of acute cerebral ischaemia. Lancet Neurol. 3(1):39-45, 2004
                                                                                          30. Lee SH et al: Comparative analysis of the spatial distribution and severity of cerebral microbleeds and old lacunes. J Neurol Neurosurg Psychiatry. 75(3):423-7, 2004
                                                                                          31. van Straaten EC et al: Operational definitions for the NINDS-AIREN criteria for vascular dementia: an interobserver study. Stroke. 34(8):1907-12, 2003
                                                                                          32. Cohen RA et al: The relationship of subcortical MRI hyperintensities and brain volume to cognitive function in vascular dementia. J Int Neuropsychol Soc. 8(6):743-52, 2002
                                                                                          33. Schmidt R et al: Evolution of white matter lesions. Cerebrovasc Dis. 13 Suppl 2:16-20, 2002
                                                                                          34. Schmidt R et al: Risk factors and progression of small vessel disease-related cerebral abnormalities. J Neural Transm Suppl. (62):47-52, 2002
                                                                                          35. Schmidt R et al: The natural course of MRI white matter hyperintensities. J Neurol Sci. 203-204:253-7, 2002
                                                                                          36. Udaka F et al: White matter lesions and dementia: MRI-pathological correlation. Ann N Y Acad Sci. 977:411-5, 2002
                                                                                          37. van Den Boom R et al: Subcortical lacunar lesions: an MR imaging finding in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. Radiology. 224(3):791-6, 2002
                                                                                          38. Varma AR et al: Diagnostic value of high signal abnormalities on T2 weighted MRI in the differentiation of Alzheimer's, frontotemporal and vascular dementias. Acta Neurol Scand. 105(5):355-64, 2002
                                                                                          39. Auer DP et al: Differential lesion patterns in CADASIL and sporadic subcortical arteriosclerotic encephalopathy: MR imaging study with statistical parametric group comparison. Radiology. 218(2):443-51, 2001
                                                                                          40. Wahlund LO et al: A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke. 32(6):1318-22, 2001