Cerebrovascular Disease

Cerebrovascular disease is one of the causes of stroke

Cerebrovascular disease is one of the risk factors of stroke. Often, cerebrovascular disease in combination with other stroke risk factors can result in a stroke.

What is Cerebrovascular Disease?

Cerebrovascular disease is disease of the blood vessels in the brain, especially the arteries in the brain. Arteries in the brain deliver blood that supplies vital nutrients and oxygen to the brain tissue. Cerebrovascular disease develops over time because the blood vessels in the brain are susceptible to damage caused by hypertension or intermittent high blood pressure, high cholesterol, diabetes, hereditary blood vessel disease or smoking.

Injury to the inner lining of blood vessels causes them to become narrow, stiff and sometimes irregularly shaped. Often, unhealthy blood vessels are described as having atherosclerosis, a stiffening of the inner lining, usually associated with cholesterol build up.

How does cerebrovascular disease cause a stroke?

Blood vessels in the brain that have developed cerebrovascular disease are prone to blood clots. A blood clot may start forming within an artery when the artery is narrow or disfigured on the inside. When a blood clot grows inside a blood vessel it is called a thrombus. A thrombus that dislodges and travels through blood vessels to another location in the body is called an embolus. A thrombus or an embolus can get stuck in the narrow blood vessels in the brain, particularly those that have been damaged by cerebrovascular disease, causing an interruption of blood supply, called ischemia.

Irregularities and abnormalities due to cerebrovascular disease also cause the blood vessels to become more likely to tear, increasing the risk of hemorrhage, which is bleeding. In strokes caused by hemorrhage, brain tissue damage from bleeding as well as brain tissue damage from ischemia both occur simultaneously.

Often, a trigger causes long-term cerebrovascular disease to result in a sudden stroke. A thrombus caused by a blood clot traveling from the heart or the carotid arteries to the brain is a common trigger. The trigger may be sudden extreme hypertension. Another trigger that can cause cerebrovascular disease to produce a sudden stroke includes blood vessel spasm, often due to medications, drugs or sudden changes in blood pressure.

When cerebrovascular disease develops, often there is also cardiovascular disease and vascular disease present throughout the body and as well. The causes of cerebrovascular disease are similar to the causes of disease of other blood vessels. Some people are more prone to vascular disease in some blood vessels than other blood vessels.

There are some genetic conditions that cause cerebrovascular disease out of proportion to vascular disease in other parts of the body.

The consequences of cerebrovascular disease

The presence of extensive cerebrovascular disease can cause small silent strokes over time. Because the brain often has the capacity to compensate for some injuries, many people suffer from small strokes and do not experience symptoms because normal brain areas compensate by doing double duty.

Cerebrovascular disease and dementia

Cerebrovascular disease can contribute to symptoms of dementia. Some people with extensive cerebrovascular disease do not exhibit the stereotypical symptoms typically associated with strokes such as weakness, speech difficulty or vision loss, but have dementia instead. This is caused by the brain’s difficulty in integrating thoughts and memories as a result of many small strokes over time.

How to know if you have cerebrovascular disease

Often, people who have had many silent strokes due to cerebrovascular disease are surprised when they are told that their brain MRI or brain CT scan shows evidence of previous strokes.

In these situations, official brain imaging reports describe 'small vessel disease,' ‘lacunar strokes’ or ‘white matter disease.’ This incidental finding suggests that there have been silent areas of infarction that did not cause obvious symptoms. Over time, if several small silent strokes occur, a critical threshold may be reached. At this point, symptoms may suddenly become apparent if the compensatory ability of the brain is overwhelmed.

There is not usually a screening test to look for the cerebrovascular disease, although it can sometimes be detected on brain imaging studies. The absence of obvious cerebrovascular disease on a brain CT or MRI does not mean that it is not present. Controlling the risk factors that cause the development of cerebrovascular disease is the best way to reverse it and to prevent it from getting worse. Most cerebrovascular disease can be at least partially improved by lowering cholesterol, controlling blood pressure and diabetes and quitting smoking.


Weiner, William J., Goetz, Christopher G, Neurology for the Non-Neurologist, Fifth Edition, Lippincott Wiliams& Winkins, 2004

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