Chronic Small Vessel Disease on Head CT

Chronic small vessel disease or chronic microvascular ischemic changes is a very common finding on head CT as we age. Some radiologists refer to this as age related white matter changes. This appears as darker than normal brain patchy or confluent areas in the white matter of the brain, often around the ventricles and in the brain hemispheres. Often patients also have other age related changes like atrophy.

This is a chronic incidental finding found commonly on imaging in elderly patients. This represents damage to the small vessels in the brain. Commonly this is seen with high blood pressure, smoking and diabetes. Sometimes patients can have cognitive and emotional problems. Over time, patients can develop vascular dementia.

Head CT will often be the initial test to evaluate for headache, following a fall and other conditions of the central nervous system. The goal is to exclude conditions which are acute or life threatening. Strokes, bleeds, or masses. The finding of small vessel disease is almost always chronic. This can be demonstrated best when prior studies are seen and demonstrate stability or small amount of change.

Other possibilities for this finding can include demyelinating disorders like multiple sclerosis. Vasculitis or inflamed blood vessels in the brain and amyloid. It is therefore important to get appropriate follow up with a neurologist and possibly get a brain MRI to better evaluate. If you are having new symptoms then you should seek care immediately as it is unlikely to be related to chronic small vessel disease.