Introduction

Microangiopathy is a disease process in which the smallest blood vessels, such as capillaries, arterioles, and venules, become damaged due to aging, high blood pressure, diabetes, atherosclerosis or autoimmune diseases.

It is also known as small vessel disease or microvascular disease.

The disease process affects the fine vascular structures in the heart, kidneys, retina, or brain.
The walls of the small blood vessels thicken or become damaged.

As a result, less blood flows through the blood vessels, and less oxygen reaches the surrounding tissues. This can have serious consequences, leading to symptoms such as pain, tissue damage, or
tissue death.

Microangiopathy in the brain

Small blood vessels: major consequences

When the condition occurs in the brain it is called cerebral microangiopathy.
Sometimes the abbreviation SVD is used for cerebral microangiopathy, but CVSD is also used to indicate that it occurs in the brain, for example on this website.

Scarring
When small blood vessels in the brain are damaged and scarring occurs (gliosis), this means that important brain cells (nerve cells) are significantly damaged. These damaged cells are then replaced by "supporting glial cells." The downside is that these scars can disrupt communication between brain cells.
The changes in the brain's small blood vessels are often visible on MRI scans as white matter abnormalities.

Symptoms and consequences

Symptoms may range from mild cognitive problems such as forgetfulness to much more serious complications such as stroke, blood leakage and associated small hemorrhages, microinfarctions, lacunar infarctions. An accumulation of small and / or large cerebral infarctions may lead to vascular dementia, also known as "multi-infarct dementia" (MID).

In some people, however, this condition is completely asymptomatic.

Possible consequences

• Thinking problems, such as memory problems, difficulty concentrating, and a reduced ability to solve problems. See the cognitive consequences page
• Behavior and emotions, such as mood disorders. It is remarkable how fast mood can change. It may occur that a person suddenly reacts with irritation or impatience, see the emotions, behavior, and relationships page.
• Motor skills (movement), such as balance and coordination problems (ataxia), risk of choking (dysphagia), and difficulty articulating properly (dysarthria).

Treatment
Recovery is usually not possible, but it is important to minimize the damage as much as possible by keeping blood sugar and blood pressure under control, exercising regularly, and maintaining a healthy lifestyle.

How small is micro?

The blood vessels involved in microangiopathy are microscopic, with a diameter usually ranging between 5 and 10 micrometers. For comparison, a human hair has an average diameter of about 70 micrometers, meaning these blood vessels are much smaller and only visible under a microscope.
On average, capillaries are about 0.5 to 1 millimeter long and then merge into another capillary or a slightly smaller blood vessel.

A microaneurysm (orange arrow), vasodilation (blue arrow), and tortuous blood vessels (yellow arrow) in the retina.
View an image of the white matter damage caused by cerebral microangiopathy via this link.

Similarities and differences between cerebral SVD and cerebral microangiopathy

Cerebral small vessel disease (cerebral SVD) and cerebral microangiopathy are often mentioned in the same context because they are both conditions related to small blood vessels in the brain.
Small vessel disease is a collective term for damage to small blood vessels in various organs, such as damage caused by high blood pressure or diabetes. Cerebral small vessel disease is a term for damage to the small blood vessels of the brain.
Cerebral microangiopathy refers to damage to the small blood vessels in the brain. This is often seen on MRI scans as abnormalities in the white matter of the brain.
Both terms are used to describe damage to the small blood vessels, which can lead to problems such as strokes, cognitive decline, and vascular dementia.

The similarities and differences between lacunar Infarction, microhemorrhage, small vessel disease, microangiopathy, CAA

A very small infarction, also called a lacunar infarction, occurs due to the blockage of a small blood vessel in the brain. These infarctions are often associated with problems with the small blood vessels in the brain.

A very small cerebral hemorrhage, also called a microhemorrhage, indicates blood leakage from these small blood vessels. When such lesions occur frequently, it may be an indication of cerebral small vessel disease (cerebral SVD). SVD is characterized by structural damage to the small blood vessels, which can lead to both infarctions and hemorrhages.

In addition, the occurrence of multiple microhemorrhages or small infarctions can also indicate microangiopathy, a condition in which the small blood vessels in the body, including the brain, are damaged. In some cases, it can also involve Cerebral Amyloid Angiopathy (CAA), in which protein deposits in the walls of the small blood vessels in the brain lead to bleeding or disruptions in blood flow.

These conditions are similar in their causes and effects, but differ in their characteristics and treatment.