Hello, Microvascular ischemia is a radiographic finding that shows as very small dots or spots on the image of a brain scan which is usually an MRI. Such a condition is NOT UNCOMMONLY seen in normal subjects without any history of medical problems or complaints just based on normal aging (20-35% in HEALTHY SUBJECTS). It represents the aggregate result of microscopic blood vessel deterioration causing the tiniest amounts of deprivation of oxygenated blood to brain tissue. This is generally NOT A PROBLEM and is not likely to lead to what most people understand as SERIOUS STROKE unless being caused by things which can lead to strokes if not truly controlled such as HYPERTENSION, DIABETES, SMOKING, etc. There are multiple associated conditions with this entity (aside from what I just mentioned) such as high cholesterol, aging, atherosclerosis, heart disease, atrial fibrillation, and the list goes on and on. There is no definitive treatment. Neurologists tend not to get terribly excited when this read is made since treatment is generally directed at RISK FACTOR CONTROL or the condition is SEVERE in its amount of brain territory covered (which the radiologist will usually say in the report). I try not to prescribe anything for the most part since there are risks to taking things such as aspirin, Plavix, or Aggrenox (the most commonly used agents) and again, if the person is otherwise healthy and the finding was incidental I simply educate the patient as to what it means and how best to control associated risks as those listed above. Here s a nice little article you may find helpful https://www.healthline.com/health/microvascular-ischemic-disease#causes-and-risk-factors. Hope I have answered your query. Let me know if I can assist you further. Take care Regards, Dr Dariush Saghafi, Neurologist