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While much is understood vis a vis neuroimmunological conditions, our knowledge of the pathophysiology of these lesions, and their role in, and implications to, management of cerebrovascular diseases or stroke, especially in the elderly, are limited. Several clinical assessment tools are available for delineating white matter lesions in clinical practice. However, their incorporation into clinical decision\u2010making and specifically prognosis and management of patients is suboptimal for use in standards of care. This article sought to provide an overview of the current knowledge and recent advances on pathophysiology, as well as clinical and radiological assessment, of white matter lesions with a focus on its development, progression and clinical implications in cerebrovascular diseases. Key indications for clinical practice and recommendations on future areas of research are also discussed. Finally, a conceptual proposal on putative mechanisms underlying pathogenesis of white matter lesions in cerebrovascular disease has been presented. Understanding of pathophysiology of white matter lesions and how they mediate outcomes is important to develop therapeutic strategies.<\/jats:p>","DOI":"10.1111\/ejn.15379","type":"journal-article","created":{"date-parts":[[2021,7,7]],"date-time":"2021-07-07T17:04:11Z","timestamp":1625677451000},"page":"5531-5559","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["Emerging role of white matter lesions in cerebrovascular disease"],"prefix":"10.1111","volume":"54","author":[{"given":"Aarushi","family":"Rastogi","sequence":"first","affiliation":[{"name":"South Western Sydney Clinical School University of New South Wales (UNSW) Liverpool New South Wales Australia"},{"name":"Neurovascular Imaging Laboratory, Clinical Sciences Stream Ingham Institute for Applied Medical Research Sydney New South Wales 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