Just because it’s called SMALL vessel disease doesn’t mean it doesn’t have a BIG impact!   Small vessel disease (SVD) is a BIG contributor to vascular dementia, along w/large vessel cortical infarcts   Do YOU know all the faces of small vessel disease?   Common imaging markers of SVD include:   --White matter hyperintensities (WMHs) --Lacunes --Enlarged perivascular spaces --Microbleeds --Small subcortical infarcts --Brain atrophy   But what you see isn’t always what you get!   Even in patients w/similar degrees of SVD, clinical symptoms can be very variable.   Variability exists because of: --Perilesional penumbra --Remote effects from disruption of brain connectivity --Differing brain reserve & compensatory mechanisms   So remember, imaging findings of SMALL vessel disease are just the tip of a very BIG iceberg