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Advanced Neurology

PERSPECTIVE ARTICLE
Incidental covert cerebral small vessel

disease: Detection and management

Alina González-Quevedo * , Tania Arrieta Hernández 2† ,
1†
Marisol Peña Sánchez 1 , Zenaida Hernández Díaz 3 ,
Marianela Arteche-Prior 2 , and Javier Sánchez López 2
1 Department of Neurobiology, Institute of Neurology and Neurosurgery, Havana, La Habana
Province, Cuba
2 Department of Neurology, Institute of Neurology and Neurosurgery, Havana, La Habana Province,
Cuba
3 Department of Neuroimaginology, International Center of Neurological Restoration, Havana, La
Habana Province, Cuba

Abstract

Cerebral small vessel disease (CSVD) is one of the most common vascular diseases
of the brain, primarily diagnosed using magnetic resonance imaging biomarkers.
Advanced brain imaging techniques have enabled the detection of asymptomatic or
† These authors contributed equally covert CSVD in individuals without neurological symptoms. CSVD is highly prevalent
to this work. among the elderly and healthy community-dwelling adults with vascular risk factors. It
*Corresponding author: increases the risk of stroke, cognitive decline, and vascular dementia, and exacerbates
Alina González-Quevedo the severity of Alzheimer’s disease. Covert CSVD is generally considered incidental,
(aglez@infomed.sld.cu;
gonzalezquevedoalina@gmail.com) leading to a lack of intervention, especially among non-neurological physicians. The
relevance of CSVD in asymptomatic healthy populations remains a contentious issue.
Citation: González-Quevedo A,
Arrieta Hernández T, Peña Sánchez Despite identifying covert CSVD, management strategies are poorly established,
M, Hernández Díaz Z, posing challenges for neurologists and primary care physicians. Key debated issues
Arteche-Prior M, Sánchez López J. are: (i) the advantages of screening asymptomatic individuals concerning reduced
Incidental covert cerebral small
vessel disease: Detection and adverse health events or cost-effectiveness, (ii) effective community screening
management. Adv Neurol. strategies, including the development of non-imaging biomarkers, and (iii) the
2025;4(4):48-57. clinical and therapeutic implications of covert CSVD. Currently, limited scientific
doi: 10.36922/an.4841
evidence addresses these issues, necessitating more high-quality longitudinal
Received: September 13, 2024 studies. Increased awareness regarding the importance of detecting, treating, and
Revised: November 20, 2024 systematically monitoring covert CVDS is essential. Screening procedures should be
more active, utilizing more accessible non-imaging biomarkers such as blood tests,
Accepted: December 26, 2024
retinal assessments, and ambulatory blood pressure monitoring. The early detection
Published online: January 16, 2025 of CSVD presents an opportunity to implement more effective preventive strategies.
Copyright: © 2025 Author(s).
This is an Open-Access article
distributed under the terms of the Keywords: Cerebral small vessel disease; Cerebrovascular diseases; Brain magnetic
Creative Commons Attribution resonance imaging; Biomarkers; Lacunar infarct; White matter hyperintensities; Stroke
License, permitting distribution,
and reproduction in any medium,
provided the original work is
properly cited.
1. Introduction
Publisher’s Note: AccScience
Publishing remains neutral with The recognition of asymptomatic or covert cerebral small vessel disease (CSVD) has
regard to jurisdictional claims in
published maps and institutional gained increasing attention from the scientific community in recent years. Brain magnetic
affiliations. resonance imaging (MRI) studies in community-dwelling older adults and in those

Volume 4 Issue 4 (2025) 48 doi: 10.36922/an.4841