Brief Answer:
Small vessel disease is usually due to hypertension.

Detailed Answer:
Hi,

Thank you for posting your query.

I am Dr Sudhir Kumar, Neurologist, and would try my best to help you.

I have noted the clinical details and MRI brain findings. The possible differential diagnoses for small vessel disease are:

1. Hypertension-related: High BP is the commonest cause of small vessel disease. Sometimes, patient may not be having high BP all the time. In such patients, it is useful to check ambulatory BP recording over a few days to detect intermittent hypertension.

2. Vasculitis: Vasculitis leads to inflammation of blood vessels, leading to ischemia. Blood work such as ANA profile, C-ANCA, P-ANCA, etc and MR angiogram/cerebral angiogram could be helpful in excluding vasculitis.

3. Demyelinating illness: Demyelinating illness such as multiple sclerosis is rare at this age, so, it is less likely.

4. Migraine: If the patient gives history of frequent headache, one could consider migraine as a cause of multiple hyperintense lesions on MRI mimicking small vessel disease.

I sincerely hope my reply has helped you.

I would be pleased to answer, if you have any follow up queries or if you require any further information.
     
Best wishes,     
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX
For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar

---