Cerebral small vessel diseases (SVDs) are a leading cause of age and hypertension-related stroke and dementia. The salient features of SVDs visible on conventional brain magnetic resonance images include white matter hyperintensities (WMHs) on T2-weighted images, small infarcts, macrohemorrhages, dilated perivascular spaces, microbleeds and brain atrophy. Among these, WMHs are the most common and often the earliest brain tissue changes. Moreover, over the past two decades, large population- and patient-based studies have established the clinical importance of WMHs, notably with respect to cognitive and motor disturbances. Here, we seek to provide a new and critical look at the pathogenesis of SVD-associated white matter (WM) changes. We first review our current knowledge of WM biology in the healthy brain, and then consider the main clinical and pathological features of WM changes in SVDs. The most widely held view is that SVD-associated WM lesions are caused by chronic hypoperfusion, impaired cerebrovascular reactivity (CVR) or blood–brain barrier (BBB) leakage. Here, we assess the arguments for and against each of these mechanisms based on population, patient and experimental model studies, and further discuss other potential mechanisms. Specifically, building on two recent seminal studies that have uncovered an anatomical and functional relationship between oligodendrocyte progenitor cells and blood vessels, we elaborate on how small vessel changes might compromise myelin remodelling and cause WM degeneration. Finally, we propose new directions for future studies on this hot research topic.
Skip Nav Destination
Article navigation
April 2017
-
Cover Image
Cover Image
An MRI angiogram of the brain vasculature (arteries). Articles in the area of small vessels, dementia and chronic diseases published in Clinical Science throughout 2017 are being gathered together as a collection that can be viewed at http://www.portlandpresspublishing.com/cc/small-vessels.
Review Article|
March 28 2017
Pathogenesis of white matter changes in cerebral small vessel diseases: beyond vessel-intrinsic mechanisms
Anne Joutel;
1Genetics and Pathogenesis of Cerebrovascular Diseases, INSERM, Université Paris Diderot-Paris7, Paris, France
2DHU NeuroVasc Sorbonne Paris Cité, Paris, France
Correspondence: Anne Joutel (email [email protected])
Search for other works by this author on:
Hugues Chabriat
Hugues Chabriat
1Genetics and Pathogenesis of Cerebrovascular Diseases, INSERM, Université Paris Diderot-Paris7, Paris, France
2DHU NeuroVasc Sorbonne Paris Cité, Paris, France
3Department of Neurology, Hôpital Lariboisière, Assistance Publique des Hôpitaux de Paris, Paris, France
Search for other works by this author on:
Publisher: Portland Press Ltd
Received:
November 26 2016
Revision Received:
January 04 2017
Accepted:
January 16 2017
Online ISSN: 1470-8736
Print ISSN: 0143-5221
© 2017 The Author(s). published by Portland Press Limited on behalf of the Biochemical Society
2017
Clin Sci (Lond) (2017) 131 (8): 635–651.
Article history
Received:
November 26 2016
Revision Received:
January 04 2017
Accepted:
January 16 2017
Citation
Anne Joutel, Hugues Chabriat; Pathogenesis of white matter changes in cerebral small vessel diseases: beyond vessel-intrinsic mechanisms. Clin Sci (Lond) 25 April 2017; 131 (8): 635–651. doi: https://doi.org/10.1042/CS20160380
Download citation file:
Sign in
Don't already have an account? Register
Sign in to your personal account
You could not be signed in. Please check your email address / username and password and try again.
Could not validate captcha. Please try again.
Biochemical Society Member Sign in
Sign InSign in via your Institution
Sign in via your InstitutionGet Access To This Article
Open Access for all
We offer compliant routes for all authors from 2025. With library support, there will be no author nor reader charges in 5 journals. Check here |
![]() |