The histopathological landmarks of lipohyalinosis are irregular fibrosis and hyaline of small cerebral arteries (30-400 μm) associated with leakage of plasma proteins. It is often caused by chronic hypertension. Fibrinoid necrosis and/or endothelial dysfunction causing local inflammation (swelling) lead to vascular narrowing.
It is different from small vessel arteriosclerosis which affects slightly larger cerebral and leptomeningeal arteries (200–800 μm) and is characterised by concentric hyaline thickening with resultant concentric vascular narrowing.
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