ABSTRACT
Based on a comprehensive literature review with long-term experiences of clinical practice and researches, the authors propose the following concepts of the diagnosis, treatment and research of acute cerebral small vessel disease: (1) Cerebral small vessel disease could be grouped into acute and non-acute categories. Acute cerebral small vessel disease indicates an acute stroke due to small vessel disease, including ischemic (ie. acute lacunar stroke) and hemorrhagic (hypertensive arteriopathy- and cerebral amyloid angiopathy-related intracerebral hemorrhage) stroke. (2) Acute ischemic cerebral small vessel disease, defined traditionally by the infarction size (lacunar stroke), is regarded as the syndrome caused by a variety of mechanisms recently, although mainly characterized by lipohyalinosis in the small arterioles. The understanding of pathological mechanisms has experienced a history from autopsy observation, to inference based on risk factors, and then to direct observation of arteriole morphology using high-resolution magnetic resonance angiography. The advancement in imaging technology has brought new opportunities for studies on pathological mechanisms of cerebral small vessel disease. (3) Acute cerebral small vessel disease is manifested as acute stroke, which could be with or without the non-acute symptoms or imaging markers. (4) Individualized treatment based on the pathogenesis is the future direction for practice and research of cerebral small vessel disease. Reducing the incidence, recurrence and major outcomes (death, disability and dementia) is the main target of prevention and treatment.