Effects of suprapubic photobiostimulation on bladder function in two girls with Hinman syndrome.

Cerebral small vessel disease (CSVD) accounts for approximately 25% of ischemic strokes and for the majority of spontaneous intracerebral hemorrhages. It is also the most common cause of vascular dementia and may present as vascular parkinsonism, gait disturbance, falls, and behavioral changes (, ). CSVD markedly impairs quality of life and functional outcomes, imposing a substantial burden on patients, families, and society. Its prevalence increases with age, affecting about 5% of individuals over 50 years and nearly all of those over 90 years (). Magnetic resonance imaging (MRI)-based neuroimaging is one of the principal diagnostic approaches; characteristic findings include white matter hyperintensities (WMH), small subcortical infarcts, lacunes, enlarged perivascular spaces (EPVS), and cerebral microbleeds (CMBs) (). Importantly, these neuroimaging markers reflect different manifestations of small vessel pathology. Ischemic features, including WMH and lacunes, and hemorrhagic features, particularly CMBs, may differ in their underlying mechanisms, vascular risk factors, clinical presentations, and prognostic implications. For example, a previous study comparing lacunar infarction and subcortical hemorrhage found that ischemic and hemorrhagic consequences of CSVD showed distinct associations with vascular risk factors, neurological symptoms, in-hospital complications, and early outcomes. Given the high prevalence, substantial disease burden, and phenotypic heterogeneity of CSVD, its pathogenesis remains complex, and there are still no reliable early screening biomarkers or disease-specific interventions. Therefore, identifying accessible blood biomarkers that may help characterize CSVD and its distinct imaging phenotypes is of great significance (). Neuroinflammation is increasingly recognized as an important contributor to the pathogenesis, progression, and complications of CSVD. Multiple systemic inflammatory markers, including C-reactive protein (CRP), interleukin-6, and fibrinogen, have been shown to be associated with the severity of the disease (). Potential mechanisms involve activation of microglia and astrocytes, vascular endothelial injury, dysfunction of the neurovascular unit, and increased blood-brain barrier permeability (). These results suggest that inflammatory biomarkers may aid in the early diagnosis and risk stratification of CSVD.