Often patients will see diagnoses or imaging reports such as “lacunar cerebral infarction”, “multiple cerebral infarction”, “ischemic demyelination”, “ischemic demyelination”, “cerebral leukodystrophy”, “cerebral leukodystrophy”, etc. “cerebral white matter osteoporosis”, “cerebral leukomalacia”, etc. When patients ask this question, doctors often answer that small blood vessels are blocked. Even if the people have a small infarct, they often recover well after a period of treatment, so both patients and doctors no longer bother to look deeper, and small infarcts are left to their own devices. But this is often wrong, because this is the topic to be introduced here – cerebral small-vessel disease, which is a small lesion big problem. Cerebral small vessel disease is a group of small vessel ischemic or hemorrhagic disease in the brain, clinical manifestations of small strokes, memory loss, depression and anxiety, slow walking, dysbiosis, MRI usually shows luminal infarct foci, ischemic demyelination or cerebral white matter sparing, microhemorrhage. The reason why people and primary care physicians ignore the treatment of cerebral small vessel disease is that they only look at 1-2 stroke prognosis and ignore the important features of cerebral small vessel disease: First, the invasive nature. First, it is often detected occasionally by head imaging; second, it is cumulative. It is often said that “the accumulation of quantity, the quality of change” or “the destruction of a thousand miles of dike in an anthill”. Poor control of small vessel disease is often the main cause of vascular dementia; third, the etiology is complex. There are many different diseases that cause the manifestation of small vessel disease, so the etiology of cerebral small vessel disease is more than that of large vessel disease (i.e., narrowing of blood vessels). The etiology of cerebral small vessel disease can be broadly classified into six categories: 1. Atherosclerotic. It is highly correlated with poorly controlled hypertension or loss of circadian rhythm. The rational blood pressure in cerebral small-vessel disease is below 130/80 mmHg, which is different from the blood pressure control in large-vessel disease with vascular stenosis. 2. Disseminated or familial cerebral amyloidosis. As you know Israeli Prime Minister Sharon is a hemorrhagic stroke with cerebral amyloidosis. 3, inflammatory and immune-mediated vasculitis. 4, familial hereditary cerebral small vessel disease. It includes CADASIL, CARASIL, RVCL, COL4A1 syndrome, Fabry disease, etc. 5.Venous collagen hyperplasia. 6, Other causes, such as radioencephalopathy-related vasculopathy, etc. The final outcome of cerebral small vessel disease often leads to vascular dementia, vascular Parkinson’s syndrome, and severe inability to take care of oneself, etc. Once the symptoms appear obviously, the disease progression will be accelerated and the treatment effect will become worse and worse, so early diagnosis, early evaluation and early intervention are needed. Li Wei, Neurology Center, Beijing Tiantan Hospital It is well known that stenting is available for vascular stenosis (large vessel disease), and thrombolytic therapy in the acute phase (usually less than 6 hours) can improve it. However, thrombolysis in cerebral small-vessel disease can be effective, but it is easy to recur and cannot be stented. Vascular dementia is the most likely type of dementia to be delayed among all types of dementia, and the first cause of vascular dementia is cerebral small vessel disease, so early intervention, early evaluation, and early treatment are important means to prevent and control vascular dementia caused by cerebral small vessel disease.